Voluminous accessory cavitated uterine malformation with late clinical manifestation: A case report and literature review

Benedetta Pollano, Luís F. Vicente, Ana I. Belo, Dusan Djokovic
In: Journal of Endometriosis and Pelvic Pain Disorders · 2026 · doi:10.1177/22840265261423693 · W7129222680
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This case report details a large accessory cavitated uterine malformation (ACUM) with late clinical manifestation, emphasizing its diagnostic criteria for gynecologists and imagers considering pelvic pain and cystic myometrial lesions.

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This case report describes a rare voluminous accessory cavitated uterine malformation that presented with clinical symptoms in late adulthood. The authors review existing literature to characterize the anomaly and discuss its potential mechanisms of development and delayed manifestation. The paper highlights the diagnostic challenges associated with such structural uterine abnormalities and emphasizes the importance of thorough imaging for accurate identification. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Accessory cavitated uterine malformation (ACUM) is a possible cause of disabling dysmenorrhea. We present a case that is clinically atypical due to the late onset of symptoms (in the fourth decade of life, after pregnancy and cessation of suppressive hormone therapy), but at the same time, sonographically, fully corresponds to a typical ACUM, being one of the largest ever documented. Gynecologists and pelvic imagers should be familiar with the diagnostic criteria and consider ACUM as one of the differential diagnoses in women with pelvic pain and cystic myometrial lesion, especially when it is solitary.
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dysmenorrhea

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