Cyra M. Cottrell

The Great Masquerader: Accessory Cavitating Uterine Mass (ACUM). Evaluation, diagnosis, and surgical management

Accessory cavitating uterine masses (ACUM) are rare, cystic uterine anomalies associated with an otherwise normal uterus and reproductive tract. They are diagnosed via a presence of a noncommunicating accessory cavity lined by endometrium and surrounded by uterine smooth muscle [1]. MRI and 3D ultrasound are preferred imaging modalities for evaluation, as misdiagnosis is common [2]. Medical therapy is aimed at menstrual suppression and pain management, however these masses are likely to fail medical management. Surgical management leads to virtual complete remission of symptoms [3]. As these are uncommon, this surgical video aims to inform practitioners on diagnosis and key elements of surgical management of an accessory cavitating uterine mass (ACUM). Intraoperative videography. All patients [2] diagnosed with ACUM at an academic medical center from December 2023 to May 2024 were included. Two reproductive-aged females with dysmenorrhea found to have ACUM after imaging (3D ultrasound and MRI pelvis). Laparoscopic and robotic-assisted resection of ACUM along with diagnostic hysteroscopy, chromopertubation, and excision of endometriosis. Restoration of normal uterine anatomy and improved patient symptoms. ACUM is a rare and largely misdiagnosed Mullerian anomaly. Early recognition and surgical intervention improves patients' quality of life. Key intraoperative and postoperative considerations must be taken with surgical revision of ACUM. More data is needed on the gynecologic and obstetric outcomes associated with surgical resection of ACUM.

Use of Uterine Artery Embolization for the Treatment of Uterine Fibroids: A Comparative Review of Major National Guidelines

Fibroids cause significant morbidity, including anemia, pelvic pain, and infertility. It is imperative that healthcare providers are well-versed in the varying treatments available for fibroids. Specifically, uterine artery embolization (UAE) is a treatment that improves anemia, pelvic pain, and quality of life. The purpose of this article is to compare international guidelines on UAE to offer best practices to healthcare providers. Guidelines from the American College of Obstetrics and Gynecology, The Royal College of Obstetricians and Gynaecologists and the Royal College of Radiologists, National College of French Gynecologists and Obstetricians, The Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Society of Obstetricians and Gynaecologists of Canada, and the National Institute for Health and Care Excellence were reviewed alongside peer-reviewed PubMed articles. A comparative review of major international guidelines was conducted to encompass potential geographical, cultural, and societal variances with UAE. Review of data revealed guidelines agree with many constituents surrounding treatment of fibroids with UAE. Guidelines diverge regarding offering UAE for small fibroids, intracavitary/submucosal fibroids, and pedunculated serosal fibroids with variations on suggested imaging. Most agree that an experienced care team, including a gynecologist and interventional radiologist, should be included. Preoperative antibiotics and intrauterine device removal may be recommended. UAE for patients who desire fertility remains an option after counseling within most guidelines. UAE is a safe, efficacious, and cost-effective alternative to hysterectomy and myomectomy. Including UAE as a treatment option during the patient counseling process is critical. Guidelines vary based on data interpretation and are based on clinical research and expert opinion. Due to mixed data and lack of randomized controlled trials, organizations differ when offering UAE to patients who wish to preserve fertility. It is vital to note emerging studies supporting the safety of UAE for subsequent pregnancy.