EP26.06: The accessory cavitated uterine malformation: a scoping review

Stefan Timmerman, Laurent Stubbe, T. Van den Bosch, Wouter Froyman
In: Ultrasound in Obstetrics & Gynecology · 2023 · vol. 62(S1) , pp. 271 · doi:10.1002/uog.27120 · W4387260248
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This scoping review identified 116 cases of accessory cavitated uterine malformation, proposing a uniform definition and highlighting diagnostic challenges, typical presentation in adolescents with dysmenorrhea, and current treatment trends towards surgical intervention.

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Abstract

ACUM or “Accessory Cavitated Uterine Malformation” is a relatively rare and recently recognised uterine abnormality. It has been defined as a non-communicating accessory uterine cavity with functional endometrium, located at the insertion of the round ligament in women with an otherwise normal uterus and reproductive tract. Similar cases have been published under different terms ranging from juvenile cystic adenomyosis (JCA) to “uterus-like mass” (ULM). Some authors believe these different terms describe the same benign lesions. Our aim was to describe all cases of ACUM in the literature and formulate a uniform definition. A systematic search of the literature was performed in PubMed, Embase and Web of Science. All the articles describing a cystic myometrial lesion were reviewed, with the exclusion of myomas and sarcomas. Cases that fitted the most common definitions for ACUM/JCA were included and described in detail. Reporting was done according to the PRISMA guideline for scoping reviews. In the 54 included articles, we identified 116 cases of ACUM. Median age at onset of symptoms was 17 years, presenting with dysmenorrhea soon after menarche. Ultrasound showed a unilocular myometrial cyst close to the insertion of the round ligament. On MRI, ACUM presented as a hyperintense nodule on T1-weighed images. In 87% of cases, treatment was surgical, with a growing trend towards primary non-surgical options. A previous completed pregnancy was observed in 19 cases. We suggest ACUM to be defined as a cavitated lesion with a myometrial mantle, located in the anterolateral wall of the myometrium beneath the insertion of the round ligament, in absence of other obstructive anomalies. The diagnosis remains challenging since it has some similarities with other myometrial masses. The use of a unified definition and clear lexicon is essential for further research. Furthermore, there is a need for studies describing a non-surgical management of ACUM and follow-up.

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Condition tags

adenomyosisdysmenorrhea

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