Accessory Cavitated Uterine Mass Research Articles

Accessory cavitated uterine mass: A rare cause of severe dysmenorrhoea managed by minimally invasive surgery

Accessory cavitated uterine mass (ACUM) is a rare congenital mullerian anomaly, encountered in young, nulliparous women. It is a non-communicating cavity, lined by functional endometrium in an otherwise normal uterus, presenting with severe intractable dysmenorrhoea. On ultrasound, it is a striking myometrial lesion but often misdiagnosed due to unfamiliarity. Though studies have described medical management, recurrence of symptoms occurs after discontinuing treatment. Surgical management, either conservative, by excising the lesion completely, or hysterectomy, can resolve the symptoms. Here, we report a 29-year old nulligravida with primary infertility presenting with severe dysmenorrhoea, unresponsive to analgesics. She was preoperatively diagnosed to have an ACUM and was managed by conservative minimally invasive surgery. Histopathology showed endometrium with secretory activity surrounded by myometrium, consistent with our findings. On postoperative follow-up, patient reported complete recovery from dysmenorrhoea. Appropriate diagnosis of this rare entity is a true challenge because of lack of awareness and the wide range of close differential diagnoses. It is imperative to understand and distinguish this peculiar lesion, with an ultimate aim of performing timely surgery, for complete symptom alleviation, especially when fertility is a concern.

Accessory cavitated uterine mass in a young female with chronic pelvic pain and dysmenorrhea

Accessory and cavitated uterine mass is a rare form of developmental Mullerian anomaly seen in young females, which presents as chronic recurrent pelvic pain and severe dysmenorrhea. Hysterosalpingography (HSG), ultrasonography, and magnetic resonance imaging (MRI) are the mainstay of diagnostic imaging. This entity is often underdiagnosed; therefore, a high index of suspicion combined with HSG and MRI imaging can help in making an accurate and timely diagnosis and thus prevent unnecessary interventions.

Accessory cavitated uterine mass in a multiparous patient with progressive dysmenorrhea

Accessory cavitated uterine mass in a multiparous patient with progressive dysmenorrhea

Impact of an accessory cavitated uterine mass on fertility: case presentation and review of the literature

We report a case of an accessory cavitated uterine mass (ACUM) in a patient with infertility and chronic pelvic pain. In addition, we summarize the literature to better characterize ACUM diagnosis and management. A comprehensive literature search using the PubMed database was performed through April 2023. Historical ACUM diagnostic criteria were applied as inclusion criteria. Descriptive statistics and statistical evaluation were reported. A 31-year-old nulligravid woman presented with chronic pelvic pain, dysmenorrhea, primary infertility, and history of endometriosis. Three-dimensional ultrasonography identified an ACUM and laparoscopic excision provided complete resolution of symptoms. Subsequently, she conceived without assistance twice with uncomplicated vaginal deliveries. A total of 154 articles were identified, 34 papers met inclusion criteria and were individually reviewed, consisting of 70 reported cases. The most common presenting complaints were dysmenorrhea (81.4%), chronic pelvic/abdominal pain (54.1%), and refractory pain (34.3%). Diagnostic imaging included magnetic resonance imaging (62.9%) and transvaginal ultrasound (55.7%). Management included resection via laparoscopy (75.7%) or laparotomy (18.6%), or hysterectomy (5.7%). Of cases with reported outcomes, 90.7% had complete relief of symptoms after surgery. ACUM often presents with dysmenorrhea, chronic pelvic pain, or abdominal pain and is identifiable on magnetic resonance imaging as a hyperenhancing mass. Three-dimensional transvaginal ultrasound can also accurately identify ACUM. A total of 90.7% of patients had complete relief of symptoms after intervention. It is important to identify ACUM early to relieve pain and reduce unnecessary interventions. Like our patient, other reports have demonstrated concomitant infertility and endometriosis. However, further investigation is needed to explore the association between infertility and ACUM.

Accessory cavitated uterine mass (ACUM) as a miniature uterine anomaly causing severe lateralized dysmenorrhea: case series.

Our study aimed to retrospectively analyse and present the clinical course of accessory cavitated uterine mass (ACUM), a rarely diagnosed uterine malformation. The study group comprised 5 adolescents that were treated in the Division of Gynecology, Clinical Hospital of Obstetrics and Gynecology of Poznan University of Medical Sciences, between October 2017 and August 2022. Patients' age at diagnosis of ACUM ranged from 14.1 to 27.5 (mean 21.4) years. All patients complained of severe dysmenorrhea with significant lateralisation of the pain. Pelvic ultrasound (US) followed by pelvic magnetic resonance imaging (MRI) revealed the presence of a small cystic lesion surrounded by a ring of myometrium within or in connection with the regular uterine body. In four patients (80%), the lesion was on the right side, and in one patient (20%) on the left side. The volume of the ACUM cavity ranged from 0.04 to 2.4 (mean 0.8) cm³. Laparoscopic excision of ACUM, located near the uterine attachment of the round ligament, was performed in all five cases and resulted in the complete resolution of symptoms. None of the patients was diagnosed with adenomyosis or pelvic endometriosis. ACUM is a small, surgically correctable cause of severe dysmenorrhea in young females with an otherwise normal uterus. The lateralisation of the menstrual pain should prompt the search for this malformation with imaging techniques (US, MRI). ACUM laparoscopic excision results in complete relief of symptoms. ACUM is not associated with pelvic endometriosis.

Accessory cavitated uterine mass: two cases of an atypical uterine anomaly

Accessory cavitated uterine mass: two cases of an atypical uterine anomaly

Juvenile cystic adenomyosis or accessory cavitated uterine mass (case report)

Juvenile cystic adenomyosis or accessory cavitated uterine mass (case report)

Accessory cavitated uterine malformation: Enhancing awareness about this unexplored perpetrator of dysmenorrhea.

An accessory cavitated uterine mass (or malformation) (ACUM) is an isolated cystic uterine lesion located at the lateral aspect of the myometrium just below the insertion of the round ligament. Often the source of severe dysmenorrhea and pelvic pain, this condition is classified as a Müllerian abnormality. Understanding ACUMs, recognizing their clinical appearance, diagnosing an ACUM with ultrasound or magnetic resonance imaging, and advising patients about conservative, medicinal, and surgical treatment options is important to all clinicians. Although ACUM primarily presents with severe dysmenorrhea but can have other clinical symptoms, we have provided a few sample cases to help clinicians prepare for ACUM encounters. We also reviewed the other published literature available on ACUM regarding clinical presentation, etiology, and management. Last but not least, based on our research and the work of others, we offer a set of characteristics that will be useful in diagnosing and treating ACUM. ACUM diagnosis is crucial in clinically suspicious circumstances, and early treatment significantly enhances patients' quality of life.

Imaging features of accessory cavitated uterine mass (ACUM): a peculiar yet correctable cause of dysmenorrhea.

Accessory cavitated uterine mass (ACUM) is a rare form of developmental mullerian anomaly which causes chronic pelvic pain, dysmenorrhea and infertility in young females. It is a non-communicating, accessory cavity within an otherwise normal uterus, lined by functional endometrium and surrounded by myometrium-like smooth muscle cells which imparts it uterus-like appearance. USG and MRI are the imaging modalities which help in reaching the diagnosis. Knowledge of this entity and awareness of its imaging features can help diagnose this often underdiagnosed and surgically correctable cause of dysmenorrhea.

Forty-two normomenstruating adolescents with Müllerian obstructive anomalies: Presentation, pitfalls in the dagnosis and surgical management.

We analyzed the frequency, presentation and pitfalls in the diagnosis and surgical management of a large group of normomenstruating adolescents with obstructive reproductive tract anomalies. Retrospective analysis of prospectively collected data. Of the 143 outpatients referred for severe dysmenorrhea and persistent pelvic pain, 42 (29.3%) young women with obstructive Müllerian anomalies and regular menstrual flow were identified. These patients were divided into four groups: (1) patients with duplicate uterine cavities, obstructed hemivagina and ipsilateral renal agenesis (n=34); (2) patients with unicornuate uterus and noncommunicating cavitated rudimentary horn (n=5); (3) patients with accessory cavitated uterine mass (n=2); (4) patients with partially obstructed transverse vaginal septum (n=1). All 42 patients were conservatively treated via laparoscopy and 35/42 patients had also vaginal surgery. Of the four groups, patients in groups 2 and 3 (n=7) were conservatively managed by laparoscopy alone; for patients in groups 1 and 4 (n=35), laparoscopy and the vaginal approach were used. Patients of group 1 were treated by resecting the obstructed vaginal septum with drainage of retained collections. In patients in group 2, surgery consisted of the removal of the rudimentary horn. Patients of group 3 were treated by the removal of myometrial neoformations. In the patient in group 4, treatment consisted of removal of the septum. All surgical procedures were successful and no major complications were recorded. Follow-up reports highlighted the disappearance of obstruction and clear improvement in pain symptoms. Unilateral obstructive anomalies of the female genital tract are difficult to identify. Early diagnosis allows the preservation of reproductive activity and avoids potential complications.

OP03.03: Accessory cavitated uterine mass in a woman with infertility: crucial role of three‐dimensional ultrasound

OP03.03: Accessory cavitated uterine mass in a woman with infertility: crucial role of three‐dimensional ultrasound

106 Accessory cavitated uterine mass (ACUM): A rare uterine obstructive anomaly diagnosed in menstruating girls and young women with severe dysmenorrhea (case series)

Introduction: Uterine obstructive anomalies, that should be considered as a cause of severe dysmenorrhea in girls and young women, involve: obstructed uterine horn, unilateral cervical aplasia and Robert’s uterus. In contrast to these anomalies, the accessory cavitated uterine mass (ACUM) is diagnosed in patients with a normal shape of the uterine cavity.

A rare case of the new entity of müllerian anomalies mimicking the noncommunicating rudimentary cavity with hemi-uterus: accessory cavitated uterine mass

To demonstrate the laparoscopic excision of an accessory cavitated uterine mass (ACUM) and show that atypical anomalies can lead to the misdiagnosis of a noncommunicating rudimentary horn. Description and step-by-step demonstration of the surgical procedure using a video recording (Canadian Task Force Classification 3). University hospital. A 17-year-old virgin girl with chronic pelvic pain and severe progressive dysmenorrhea despite using nonsteroidal anti-inflammatory drugs and oral contraceptives since her menarche. We could not perform transvaginal examination and ultrasonography because of the virginity of the girl. Transabdominal ultrasound revealed a 24 × 24-mm heterogeneous cystic mass on the left adnexal region suggesting a noncommunicating functional rudimentary horn. This mass was within the left lateral uterine myometrial wall, and otherwise, the uterus and endometrial cavity seemed normal on ultrasonographic examination. Magnetic resonance imaging showed a cavitated nodule of 25 mm with hemorrhagic components inside the mass on the left side of the uterus and the normal endometrial cavity with a normal size uterus. After detailed evaluation and counseling, a decision was taken to perform laparoscopy. Laparoscopic resection of the ACUM. On laparoscopic exploration, we first observed a globular enlargement on the left wall of the uterus under the round ligament. Both the ovaries and the uterus were normal, and there were two normally developed fallopian tubes with no abnormality communicating with the normal uterus. The mass had irregular muscle fibers and ambiguous limits for detaching from the normal myometrial tissue. Afterward, the mass was resected completely without entering the endometrial cavity. It was thought that these irregular borders may be a factor of confusion as a degenerated myoma on the diagnosis. The blunt and sharp dissection methods were used bidirectionally, and finally, the lesion was enucleated. The mass was incised, and chocolate-like brownish fluid spilled out from the cavity of the mass. The endometrium-like epithelium and surrounding muscular layer were seen on the mass. The myometrial defect was approximated and closed with a polyglactin absorbable suture. Histopathological examination revealed the endometrial lining cavitated mass surrounded by myometrium, and thus, it was consistent with the diagnosis of ACUM. The postoperative period of the patient was uneventful. She was discharged without any complaint. Her severe pelvic pain and symptoms of dysmenorrhea were resolved 1 month after the surgery. We did not prescribe any medication for menstrual suppression and pain management before or after surgery. During the follow-up period, she had a regular menstrual cycle and no pelvic pain and dysmenorrhea for 2 years. Accessory cavitated uterine mass is a new entity having a normal endometrial cavity and is different from other müllerian duct anomalies. Severe dysmenorrhea and chronic pelvic pain are early-onset, and they are persistent despite using medications, but suspecting this problem is the main determinant for confirming the diagnosis. The final diagnosis of ACUM can be made after resecting the mass and confirming with histopathological examination. Accessory cavitated uterine mass may be confused with a similar lesion of juvenile cystic adenomyosis (JCA). They present very similar clinical and pathological findings, but JCA is a rare form of focal adenomyosis that contains cystic contents inside the lesion, and it has more intense adenomyosis surrounding the endometrial lining of a cavitated mass. In our case, histopathological examination revealed muscle fibers around the endometrial epithelium, with no adenomyotic foci. It was so difficult to distinguish these two similar lesions during the surgery. Thus, we could distinguish ACUM from JCA with this pathological confirmation. Accessory cavitated uterine mass may also be misdiagnosed as U4a of ESHRE/ESGE classification and 2b of ASRM classification, but it should be distinguished from these anomalies. Moreover, it is important to define ACUM clearly in the U4 or U6 class of the ESHRE/ESGE and 2b of ASRM classification systems.

Decidualized Juvenile Cystic Adenomyoma Mimicking a Cornual Heterotopic Pregnancy

<h3>Study Objective</h3> To describe a rare case of a juvenile cystic adenomyoma presenting as a heterotopic pregnancy. <h3>Design</h3> Case report. <h3>Setting</h3> Private teaching hospital. <h3>Patients or Participants</h3> A 26-yo G3P1 at 7wga presented to the emergency department with complaint of vaginal spotting and mild cramping. Ultrasound identified a heterotopic pregnancy. An intrauterine pregnancy was noted with a 1.9cm gestational sac, a 1.1cm CRL, and FHR 161bpm. A second gestational sac was noted in the posterior left uterus measuring 1.58cm with CRL 0.94cm and <5mm of myometrium surrounding the sac. No cardiac activity detected. <h3>Interventions</h3> The patient was counseled regarding options for management including abortive vs non-abortive, medical vs surgical. She ultimately decided to undergo surgical treatment with preservation of the intrauterine pregnancy. Intraoperative laparoscopic ultrasound was performed with similar findings. Robotic assisted cornual wedge resection and removal of the ectopic mass was performed with preservation of the ipsilateral fallopian tube and intrauterine pregnancy. <h3>Measurements and Main Results</h3> Final pathology failed to demonstrate any fetal tissue, but rather demonstrated cystic adenomyoma. <h3>Conclusion</h3> Juvenile cystic adenomyosis (JCA) is a rare form of focal adenomyosis which is usually located near the uterine insertion of the round ligament, contains a cystic inner area >1cm and is encountered before the age of 30 years. Some authors report JCA to be an accessory cavitated uterine mass (ACUM) anomaly developing because of gubernaculum dysfunction. The only difference between the two conditions is the presence of a denser area of adenomyosis surrounding the cystic area lined with endometrium in JCA. This case demonstrates decidual changes observed in ectopic endometrial tissue within an area may be misdiagnosed as a focus of ectopic pregnancy. In non-emergency situations, waiting for the decidualization effect of ectopic endometrium to subside can help in the definitive diagnosis of such cases.

Imaging Manifestations of Accessory Cavitated Uterine Mass-A Rare Mullerian Anomaly.

Context Accessory cavitated uterine mass (ACUM) is an uncommon and under-recognized entity with distinct imaging characteristics and causing significant patient distress. Differentiating it from its other clinical and radiological differentials is therefore extremely important and prevents delay in surgical management which is the treatment of choice. Aims The aim of the study is to describe the MRI appearance of the surgically and pathologically proven ACUM cases from our institution in the last 2 years. Settings and Design This is a retrospective study in a tertiary care hospital in South India. Methods and Material We reviewed the clinical presentations and imaging findings of seven surgically proven cases of ACUM qualifying the proposed diagnostic criteria. Results All patients presented with chronic pelvic pain, dysmenorrhea, and prolonged post-menstrual pain. MRI in all seven cases showed an intramural, noncommunicating, and cavitating lesion near the uterine cornua with internal contents similar to that of endometrioma. Although the cavity was lined by endometrium in all the cases (proven in pathology), it was well appreciable on MRI in only five cases. The rest of the uterine myometrium and main endometrial cavity were normal with no features of adenomyosis. Conclusion MRI is a reliable diagnostic tool for accurate diagnosis of ACUM, and more importantly, in distinguishing it from other causes of chronic pelvic pain like adenomyosis and endometriosis and other imaging differentials like adenomyoma, noncommunicating uterine horn, and degenerating leiomyoma.

Accessory Cavitated Uterine Mass: An Emerging Differential Diagnosis of Dysmenorrhea in Adolescents

A 14-year-old female presented with complaints of severe dysmenorrhea for 6 months. She attained menarche at the age of 12 years, with previous cycles being regular. Her symptoms persisted despite previous medical management for the same.

Laparoscopic Management of Accessory Cavitated Uterine Mass: A Report of Two Cases and Review of Literature

Background: Accessory cavitated uterine mass (ACUM) is a rare congenital anomaly of Mullerian ducts that presents with severe dysmenorrhea in young women. It responds poorly to medication and requi...

An unusual case of Mullerian anomaly: "accessory cavitated uterine mass"

The present study presents a case report of a rare anomaly called accessory cavitated uterine mass (ACUM). The patient, 26 years old, had presented with severe dysmenorrhea which was refractory to the medical treatment. The hysteroscopic examination was normal and laparoscopic examination showed a subserosal bulge, present over anterior and lateral fundal region above the attachment of the round ligament. Chromo-pertubation was performed and dye came freely from both the tubes but not from the cavity of this uterine mass. The chocolate-colour material was drained during excision of the mass. The final histopathology report showed myometrial tissue lined by collection of hemosiderin laden macrophages as well as endometrial cuboidal lining and occasional endometrial glands.

Sonografic features of accessory cavitated uterine mass (ACUM) successfully treated with robotic assisted laparoscopic surgery- a case report

Sonografic features of accessory cavitated uterine mass (ACUM) successfully treated with robotic assisted laparoscopic surgery- a case report

EP15.01: Sonographic features in two cases with accessory cavitated uterine mass (ACUM) successfully treated with robotic‐assisted laparoscopic surgery

EP15.01: Sonographic features in two cases with accessory cavitated uterine mass (ACUM) successfully treated with robotic‐assisted laparoscopic surgery