Accessory cavitated uterine mass: an underdiagnosed condition and a diagnostic challenge

K Sushrith Kumar Yadav, Deepshikha Jaiswal
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2025 · vol. 15(1) , pp. 342–345 · doi:10.18203/2320-1770.ijrcog20254309 · W7117541577
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Accessory cavitated uterine mass (ACUM), a rare Müllerian anomaly mimicking other gynecological conditions, was diagnosed intraoperatively in a patient with refractory pelvic pain and treated with surgical resection for symptom resolution.

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This paper describes a rare Müllerian duct anomaly, accessory cavitated uterine mass (ACUM), and reports a diagnostic challenge in a 28-year-old multiparous woman with a three-year history of severe, progressive dysmenorrhea and chronic pelvic pain that was refractory to standard medical management. Pelvic ultrasound and MRI suggested other diagnoses, such as endometriosis or chronic ectopic pregnancy, but intraoperative assessment identified a rudimentary horn–like non-communicating cavity within the myometrium lined by functional endometrium, filled with fluid, consistent with ACUM. Surgical resection of the accessory uterine cavity was associated with complete symptom resolution. The paper is a single-case report and does not establish diagnostic accuracy or generalizable imaging criteria, but it emphasizes considering ACUM when severe dysmenorrhea and chronic pelvic pain do not respond to initial treatment. Relevance to endometriosis: endometriosis was specifically raised as a leading preoperative imaging differential diagnosis in this ACUM case, though the paper’s main focus is the underdiagnosis and diagnostic pitfalls of ACUM.

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Abstract

Accessory cavitated uterine mass (ACUM) is a rare Müllerian duct anomaly characterized by a non-communicating, cavitated lesion within the myometrium, lined by functional endometrium. ACUM often mimics other gynaecological disorders such as endometriosis, cystic adenomyoma, leiomyoma or cornual ectopic pregnancy, leading to diagnostic delays and significant morbidity. We present the case of a 28-year-old multiparous woman with a three-year history of severe, progressive dysmenorrhea and chronic pelvic pain refractory to standard medical management. Pelvic ultrasonography and MRI suggested possible endometriosis or chronic ectopic pregnancy. Definitive diagnosis achieved intraoperatively, a rudimentary horn–like, non-communicating cavity was identified, filled with fluid and surrounded by normal myometrium, consistent with ACUM. The patient underwent surgical resection of the accessory uterine cavity, resulting in complete resolution of her symptoms. This case underscores the importance of considering ACUM in the differential diagnosis of young nulliparous as well as multiparous women presenting with severe dysmenorrhea and chronic pelvic pain, especially when symptoms are refractory to initial treatment. Increased clinical awareness of ACUM's characteristic features is essential to reduce diagnostic delay and improve patient outcomes.
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Accessory cavitated uterine mass: an underdiagnosed condition and a diagnostic challenge DOI: https://doi.org/10.18203/2320-1770.ijrcog20254309Keywords: Müllerian anomaly, Juvenile cystic adenomyoma, Accessory cavitated uterine mass, Severe dysmenorrheaAbstract Accessory cavitated uterine mass (ACUM) is a rare Müllerian duct anomaly characterized by a non-communicating, cavitated lesion within the myometrium, lined by functional endometrium. ACUM often mimics other gynaecological disorders such as endometriosis, cystic adenomyoma, leiomyoma or cornual ectopic pregnancy, leading to diagnostic delays and significant morbidity. We present the case of a 28-year-old multiparous woman with a three-year history of severe, progressive dysmenorrhea and chronic pelvic pain refractory to standard medical management. Pelvic ultrasonography and MRI suggested possible endometriosis or chronic ectopic pregnancy. Definitive diagnosis achieved intraoperatively, a rudimentary horn–like, non-communicating cavity was identified, filled with fluid and surrounded by normal myometrium, consistent with ACUM. The patient underwent surgical resection of the accessory uterine cavity, resulting in complete resolution of her symptoms. This case underscores the importance of considering ACUM in the differential diagnosis of young nulliparous as well as multiparous women presenting with severe dysmenorrhea and chronic pelvic pain, especially when symptoms are refractory to initial treatment. Increased clinical awareness of ACUM's characteristic features is essential to reduce diagnostic delay and improve patient outcomes. Metrics References Grimbizis GF, Campo R. Congenital malformations of the female genital tract: the need for a new classification system. Fertility and Sterility. 2010;94(2):401–7. DOI: https://doi.org/10.1016/j.fertnstert.2010.02.030 He W, Chen S, Zhu L, Lang J. Accessory and cavitated uterine mass (ACUM) in an 18-year-old woman: a rare Müllerian anomaly. Medicine (Baltimore). 2022;101(6):e28797. DOI: https://doi.org/10.21203/rs.3.rs-1120568/v1 Anitha GS, Soundararajan P, Babu SM, Reddy SD. Two case reports of accessory cavitated uterine mass (ACUM): an unusual cause of dysmenorrhea. Int J Reprod Contracept Obstet Gynecol. 2023;12(12):3664–9. DOI: https://doi.org/10.18203/2320-1770.ijrcog20233653 Rajarajeswari S, Nandhana M. A rare cause of dysmenorrhea: Accessory cavitated uterine mass (ACUM). Int J Reprod Contracept Obstet Gynecol. 2023;12(5):1472–5. Kalokhe C, Bhosale A. Case report on Accessory and Cavitated Uterine Mass: a rare Müllerian anomaly. Int J Reprod Contracept Obstet Gynecol. 2025;14(1):267–9. DOI: https://doi.org/10.18203/2320-1770.ijrcog20243966 Manasa M, Shobha Rani R, Shwetha R. Accessory cavitated uterine mass: a rare cause of severe dysmenorrhea. Int J Reprod Contracept Obstet Gynecol. 2024;13(5):1501–4. Cozzutto C. Uterus-like mass replacing ovary: report of a new entity. Arch Pathol Lab Med. 1981;105(10):508–11. Timmerman S, Stubbe L, Van den Bosch T, Van Schoubroeck D, Tellum T, Froyman W. Accessory cavitated uterine malformation (ACUM): a scoping review. Acta Obstet Gynecol Scand. 2024;103(6):1036–45. DOI: https://doi.org/10.1111/aogs.14801 Dekkiche S, Dubruc E, Kanbar M, Feki A, Mueller M, Meuwly JY, et al. Accessory and cavitated uterine masses: a case series and review of the literature. Front Reprod Health. 2023;5:1197931. DOI: https://doi.org/10.3389/frph.2023.1197931 Mollion M, Host A, Faller E, Garbin O, Ionescu R, Roy C. Report of two cases of accessory cavitated uterine mass (ACUM): diagnostic challenge for MRI. Radiol Case Rep. 2021;16(11):3465–9. DOI: https://doi.org/10.1016/j.radcr.2021.07.071

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endometriosischronic_pelvic_paindysmenorrhea

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