Accessory Cavitated Uterine Mass: A case of variant Mullerian Anomaly

An accessory cavitated uterine mass (ACUM) is a rare Müllerian anomaly characterized by an extra cavity in the uterus alongside a normal uterine cavity. This condition is often seen in young, nulliparous women who present with severe dysmenorrhea and pelvic pain. 

A 28-year-old parous woman was diagnosed with a rare case of ACUM. She had a three-year history of progressively worsening dysmenorrhea that was partially alleviated by oral analgesics and hormonal medications.

MRI revealed a normal uterine cavity and a 2.1 × 2.6 cm isointense lesion on the left anterolateral side of the uterus.

The lady desired future fertility and was managed by uterine-sparing laparoscopic excision. A globular swelling was found in the left uterine wall below the round ligament during laparoscopy. After confirming the anatomy, the accessory mass was dissected and excised, and the myometrial defect was closed using a 1-0 V-Loc barbed suture. The excised mass contained a 2 × 2 cm cystic lesion filled with chocolate-colored fluid.

Histopathology confirmed the diagnosis of ACUM. The patient experienced complete relief from dysmenorrhea in her next menstrual cycle and is currently attempting natural conception.

ACUM can be effectively treated with surgery without compromising the endometrial cavity.

Source: Rajput M, Mahey R, Rana A, et al. Indian Obstetrics and Gynaecology. 2024 Jul 23;14(2).