Accessory and cavitated uterine mass: A rare cause of dysmenorrhea and chronic pelvic pain

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.

Accessory and cavitated uterine mass: A rare and unclassified mullerian anomaly

@#<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>

A case report on ACUM: a rare mullerian anomaly

Accessory and cavitated uterine mass (ACUM) is a rare, newly recognized mullerian anomaly. It is an accessory cavity lined by functional endometrium within an otherwise normal uterine cavity, in contrast to the other mullerian anomalies in which the uterus is malformed. It is often misdiagnosed as myoma, adenomyosis or adenomyoma. The entity needs expertise to diagnose as it is a rare but treatable cause of severe dysmenorrhea and chronic pelvic pain in young females with a wide range of differential diagnosis. A 30 years old female with history of one abortion 2 years back, came to infertility OPD with complaints of lower abdominal pain with severe dysmenorrhea, dyspareunia and inability to conceive since 2 years. Her menstrual cycle was regular with normal flow. USG pelvis showed subserosal fibroid of 4×3 cm in fundus region of uterus. On HSG, bilateral fallopian tubes were patent. MRI-pelvis revealed normal uterus with thick walled cavitatory lesion of size 4.1×3.6 cm with thick T2W hypointense wall similar to myometrium in continuation with right fundal wall of uterus containing blood products suggestive of ACUM. Both ovaries were normal, no obvious adnexal lesion/collection/free fluid noted in peritoneal cavity. Laparoscopy followed by laparotomy with excision of ACUM was performed. The MRI findings of an accessory cavitated uterine mass located below the attachment of round ligament with haemorrhagic contents, normal shaped uterus with normal bilateral tubes and ovaries should suggest the diagnosis of ACUM pre-operatively.

Placenta increta presenting as postabortal uterine mass and hemoperitoneum in the first trimester: A case report / 대한산부인과학회지

Placenta increta is one of lethal complications of pregnancy characterized by invasion of placenta villi into the underlying myometrium and usually presented in early postpartum period with difficult placental removal and massive bleeding. Placenta increta may complicate first and early second-trimester pregnancy loss causing profuse post-curettage hemorrhage but the lesion is rarely found and hard to diagnose. We experienced a case of hemoperitoneum caused by implanted chorionic villi on the uterine serosa regurged from uterine cavity, 6weeks after artificial abortion at gestational age of 5 weeks and 5 days.

Placenta Increta Presenting as Postabortal Uterine Mass in the First Trimester: A Case Report / 대한산부인과학회지

Placenta increta is rare, but life-threatening complication of pregnancy characterized by invasion of placenta villi into the underlying myometrium. Placenta increta is usually diagnosed in the third trimester and is associated with significant blood loss and uterine perforation or rupture as well as an increased risk of infection. It also has been described as a complication of selective pregnancy termination and spontaneous pregnancy loss in the second trimester and rarely in the first trimester. We report a case of placenta increta which was presented as uterine mass after dilatation and curettage (D and C) due to missed abortion in the first trimester.