ABSTRACT
Accessory and cavitated uterine mass (ACUM) is a rare developmental uterine anomaly that is said to develop due to duplication of ductal Mullerian tissue. It is an accessory cavity lying along the lateral wall of the uterus near the site of attachment of the round ligament and presents in young females with pelvic pain and dysmenorrhea. Histologically, the cavity is lined with endometrium and smooth muscle bundles similar to the myometrium. Ultrasound is helpful in the identification of the lesion. MRI of the pelvis is the imaging modality of choice for diagnosis. Laparoscopy and histopathology remain confirmatory. This report describes a case of ACUM in a young female who was managed by surgical excision of the mass.
ABSTRACT
@#<p style="text-align: justify;">Accessory and cavitated uterine mass is a rare developmental mullerian anomaly theorized to be related to gubernaculum dysfunction. It presents typically in young women as severe dysmenorrhea and chronic pelvic pain refractory to medical therapy. It is an accessory cavity lined by functional endometrium and surrounded by myometrium-like smooth muscle located in an otherwise normal uterus, typically located at the right anterior wall at the level of the round ligament attachment. Ultrasound, hysterosalpingography and magnetic resonance imaging are helpful tools to diagnose and distinguish this entity from a wide array of differential diagnoses. Surgical excision and histopathologic studies confirm the diagnosis and effectively relieves severe dysmenorrhea and chronic pelvic pain. This is a case of a 39 year old nulligravid who presented with severe dysmenorrhea initially diagnosed as rudimentary horn versus myoma. Excision revealed a cavitated mass containing chocolate-colored fluid within located at the right postero-fundal area. Histopathology revealed a diagnosis of accessory and cavitated uterine mass.</p>