A case report of Accessory Cavitated Uterine Mass Treated with Minimally Invasive Surgery

The current case study discusses a rare congenital condition known as Accessory Cavitated Uterine Mass (ACUM), which is a rare congenital mullerian anomaly, encountered in young, nulliparous women. It is characterized as a non-communicating cavity lined with functional endometrium, typically found in the lateral myometrium of a normal uterus. The conditiincan lead to severe dysmenorrhea, chronic pelvic pain, and subfertility. Despite advancements in diagnostic imaging such as ultrasound, MRI, and hysteroscopy, ACUM is often misdiagnosed due to its rarity and similarity to other conditions.

The case presented involves a 29-year-old nulligravida woman who experienced severe dysmenorrhea for two years and was initially misdiagnosed with an ovarian cyst and a bicornuate uterus based on previous imaging. Upon further investigation, an MRI revealed a spherical mass in the left posterolateral myometrium, leading to a provisional diagnosis of ACUM.

The patient underwent laparoscopic excision of the lesion, during which a cystic mass was confirmed, and surrounding endometriotic lesions were treated. The procedure was successful, and the patient experienced complete relief from dysmenorrhea postoperatively. Histopathological examination validated the diagnosis of ACUM, confirming the mass's endometrial lining and secretory activity. The patient was advised to plan for pregnancy after three months.

The study underscores the importance of awareness and accurate diagnosis in managing rare conditions like ACUM.Lack of knowledge and the large number of closely related differential diagnoses make it extremely difficult to make the right diagnosis of this uncommon entity. Particularly when fertility is at stake, it is critical to recognise and differentiate this unusual lesion in order to undertake prompt surgery and completely relieve symptoms.

Source:Pappachan C, et al.Accessory cavitated uterine mass: A rare cause of severe dysmenorrhoea managed by minimally invasive surgery.Indian Journal of Obstetrics and Gynecology Research. 2024: 507-510. Available at: https://www.ijogr.org/html-article/22549