“Deciphering Dysmenorrhea in an Adolescent Girl with Borderline Ovarian Tumour”: A Case Report on an Accessory and Cavitated Uterine Mass (ACUM)

Background Accessory and cavitated uterine mass (ACUM) is a newly recognized Mullerian anomaly and essentially a benign lesion. The normal-looking uterine cavity makes it different from other Mullerian anomalies. ACUMs are included in Group 4 of the updated embryological-clinical classification for female genito-urinary malformations published in Human Reproduction Update. The usual presentation is refractory dysmenorrhea in young females not responding to usual drugs. TVUS and MRI is utilised to reach the diagnosis. The common differential diagnosis are diffuse adenomyosis, myoma, and adenomyoma. Owing to its new identity among the causes of severe dysmenorrhea, its recognition is of great importance for girls suffering from the monthly agony. Our case is novel with respect to findings of concurrent ACUM and borderline ovarian tumour where treating surgeon will have tendency to give more importance to the management of the ovarian neoplasia. The idea behind reporting this case is to increase awareness for concurrent surgical treatment of benign lesions in the eligible patients. Case Presentation We are reporting a case following the CARE guidelines. A girl in her late adolescence was referred to our tertiary care oncology centre with an imaging suggestive of an ovarian tumour diagnosed coincidentally during work up for dysmenorrhea. Her chief complaints were severe and refractory dysmenorrhea since menarche. On MRI, the coexisting tiny lesion measuring 10*8 mm within the myometrium caught our attention as a probable cause of dysmenorrhea. The lesion fulfilled all the criteria for ACUM. Accordingly, she was planned for exploratory laparotomy and proceed with frozen section. The procedure executed was fertility-sparing staging of borderline tumour along with excision of the ACUM. The histopathology report confirmed it to be a stage 1a serous borderline ovarian tumour with concurrent ACUM. The patient has been planned for observation and is currently free of dysmenorrhea.

The diagnosis of ACUM is essential for its timely and appropriate treatment. Early surgical treatment can provide the symptom relief to these young women. Similar content being viewed by others

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Not applicable. Funding None. Author information Authors and Affiliations Contributions DB, A, UB, DB and RJ contributed in writing the manuscript. A did the literature search. AD performed the histological examination of the surgical specimens. All authors read and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Ethical Approval The manuscript has been read and approved by all the authors, that the requirements for authorship have been met, and each author believes that the manuscript represents honest work. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Barmon, D., Aparajita, Baruah, U. et al. “Deciphering Dysmenorrhea in an Adolescent Girl with Borderline Ovarian Tumour”: A Case Report on an Accessory and Cavitated Uterine Mass (ACUM). Indian J Gynecol Oncolog 21, 9 (2023). https://doi.org/10.1007/s40944-022-00686-1 Received: Revised: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s40944-022-00686-1