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An accessory cavitated uterine mass (or malformation) (ACUM) is an isolated cystic uterine lesion located at the lateral aspect of the myometrium just below the insertion of the round ligament. Often the source of severe dysmenorrhea and pelvic pain, this condition is classified as a Müllerian abnormality. Understanding ACUMs, recognizing their clinical appearance, diagnosing an ACUM with ultrasound or magnetic resonance imaging, and advising patients about conservative, medicinal, and surgical treatment options is important to all clinicians. Although ACUM primarily presents with severe dysmenorrhea but can have other clinical symptoms, we have provided a few sample cases to help clinicians prepare for ACUM encounters. We also reviewed the other published literature available on ACUM regarding clinical presentation, etiology, and management. Last but not least, based on our research and the work of others, we offer a set of characteristics that will be useful in diagnosing and treating ACUM. ACUM diagnosis is crucial in clinically suspicious circumstances, and early treatment significantly enhances patients' quality of life., (© 2023 International Federation of Gynecology and Obstetrics.)

Introduction: Accessory cavitated uterine malformation (ACUM) is a relatively recent term used to describe a noncommunicating, accessory uterine cavity. ACUM have been published under different terms ranging from juvenile cystic adenomyosis to "uterus‐like mass". The objective of this study was to systematically identify all cases of ACUM and definitions described in the literature, regardless of label, and identify morphological, epidemiological, and clinical characteristics as well as management, while also highlighting knowledge gaps. Material and methods: A systematic literature search of three databases was performed, reviewing all records of cystic myometrial lesions. Cases that fitted common definitions for ACUM were included and clinical and imaging characteristics were documented in detail. This work was registered to PROSPERO and reporting followed PRISMA guidelines for scoping reviews. Results: A total of 53 articles were included, comprising 115 cases that met the minimal criteria for ACUM. The median age at onset of symptoms was 17 years, presenting with dysmenorrhea soon after menarche. A total of 19 women were parous. On ultrasound, ACUM appears as unilocular myometrial cysts, usually with ground‐glass content. Hemorrhagic content is also observed on magnetic resonance imaging (MRI), with high signal intensity on both T2 and T1‐weighted images. Ninety‐five (83%) cases were managed surgically, with a trend towards primary nonsurgical options. Although no adverse outcomes were reported, long‐term follow‐up on subsequent fertility and pregnancy was rare. Conclusions: Despite its increasing recognition as a clinical entity, ACUM often remains underdiagnosed as it shares similarities with other myometrial masses. We propose a unified terminology and definition for ACUM based on the data in this review. ACUM presents as a cavitated lesion, surrounded by a myometrial mantle, in continuity with the anterolateral uterine wall and located beneath the insertion of the round ligament and the interstitial portion of the fallopian tube. In contrast to other uterine abnormalities, a normal uterine cavity is visualized. Future studies are needed, using a clear definition for ACUM, and prospectively investigating management strategies, including long‐term follow‐up of patient‐reported symptoms, fertility, and pregnancy outcomes. [ABSTRACT FROM AUTHOR]

ObjectiveTo explore the ultrasound characteristics of accessory cavitated uterine malformation (ACUM) and the causes of misdiagnosis, in order to better understand the disease and improve the diagnostic ability of radiologists.MethodsWe retrospectively collected clinical, pathological and imaging data of ACUM patients who were diagnosed after surgery at Peking Union Medical College Hospital from December2013 to December 2023. Besides, we analyzed ultrasound features of ACUM and the cause of misdiagnosis.ResultsA total of 11 patients were included, with a mean age of diagnosis of (27.1±7.4)years. There was a mean interval of (6.1±5.5)years between menarche and onset of dysmenorrhea. Preoperative ultrasound showed that ACUM appeared as solitary lesions located under the insertion of the round ligament, with a mean maximum diameter of (3.0±1.0)cm. Lesions were round or oval (90.9%, 10/11) and not connected to the uterine cavity (100%, 11/11) with clear boundaries (72.7%, 8/11), presenting as regular thick-walled cystic-solid structures. Cystic areas were observed within the mass (100%, 11/11) with a ground-glass-like appearance (90.9%, 10/11) and hyperechoic endometrial lining (90.9%, 10/11). The surrounding of the mass showed hypoechoic or isoechoic areas resembling the muscular layer and circular or semi-circular vascularity was detected around the mass. No adenomyosis or other uterine lesions were found. Analysis of misdiagnosis: Among the 11 ACUM cases, 6 were correctly diagnosed by the initial ultrasound examination, and 5 cases by MRI. Two patients were misdiagnosed as residual horn uterus by MRI, despite ultrasound suggesting ACUM with visible bilateral uterine horns.ConclusionsACUM exhibits distinct ultrasound characteristics. When young women present with progressive dysmenorrhea and ultrasound reveals a regular cystic-solid mass with thick wall located under the round ligament insertion, ACUM should be considered.

Accessory cavitated uterine malformation (ACUM) is a rare obstructive organ malformation, often found in young women, with the main clinical manifestations of progressively aggravated dysmenorrhea and recurrent pelvic pain. It should be differentiated from cystic adenomyopathy, congenital uterine cyst and residual horn uterus. At present, surgery is the most effective treatment. We report a married female patient with dysmenorrhea for 4 years, paroxysmal lower abdominal pain radiating to the perineum and back, progressively aggravated, requiring oral painkillers. In August 2023, gynecological vaginal ultrasound showed that the right side of the uterus was about 3.5 cm×2.7 cm heterogeneity nodular echo, the visible range was about 1.1 cm×0.6 cm small echoless area, the nature of which was to be determined. Laparoscopic exploration was performed. The uterus was normal in size, centered, and rosy. The appearance of bilateral fallopian tubes and ovaries was normal. On the right side of the uterus near the uterine horn, there was a slightly outward protrusion between the fallopian tube and the right round ligament. A hard muscular mass of about 3 cm in diameter was exfoliated from the protrusion. After incision, a space was found with dark-red fluid flowing out. The tumor was completely resected for examination and the diagnosis was confirmed as ACUM by pathological analysis. The symptoms disappeared in the post-operative follow up. [ABSTRACT FROM AUTHOR]

Objectives: Our study aimed to retrospectively analyse and present the clinical course of accessory cavitated uterine mass (ACUM), a rarely diagnosed uterine malformation. Material and methods: The study group comprised 5 adolescents and young adult women that were treated in the Division of Gynecology, Clinical Hospital of Obstetrics and Gynecology of Poznan University of Medical Sciences, between October 2017 and August 2022. Patients' age at diagnosis of ACUM ranged from 14.1 to 27.5 (mean 21.4) years. All patients complained of severe dysmenorrhea with significant lateralisation of the pain. Results: Pelvic ultrasound (US) followed by pelvic magnetic resonance imaging (MRI) revealed the presence of a small cystic lesion surrounded by a ring of myometrium within or in connection with the regular uterine body. In four patients (80%), the lesion was on the right side, and in one patient (20%) on the left side. The volume of the ACUM cavity ranged from 0.04 to 2.4 (mean 0.8) cm3. Laparoscopic excision of ACUM, located near the uterine attachment of the round ligament, was performed in all five cases and resulted in the complete resolution of symptoms. None of the patients was diagnosed with adenomyosis or pelvic endometriosis. Conclusions: ACUM is a small, surgically correctable cause of severe dysmenorrhea in young females with an otherwise normal uterus. The lateralisation of the menstrual pain should prompt the search for this malformation with imaging techniques (US, MRI). ACUM laparoscopic excision results in complete relief of symptoms. ACUM is not associated with pelvic endometriosis. [ABSTRACT FROM AUTHOR]

This report described three cases with long-term severe dysmenorrhea, and these cases were referred to our department for medical help. The diagnosis of accessory cavitated uterine malformation (ACUM) was considered based on symptoms and ultrasound/MRI findings. Moreover, a combined approach involving hysteroscopic surgery and laparoscopic surgery was undertaken, and no complications occurred during surgery and in the post-operative period. It is important to consider ACUM in patients with severe dysmenorrhea that does not respond to medical management. Surgery is the most effective treatment for this anomaly.

Accessory cavitated uterine malformation (ACUM) is a rare form of Müllerian anomaly, usually presents with progressive and aggravating dysmenorrhea from menarche. It should be distinguished from cystic adenomyoma, degenerating cystic leiomyoma and the other form of obstructive Müllerian anomaly. Surgery is its main treatment option. In this study, we present an adolescent female with progressive worsening dysmenorrhea, nausea and vomiting, pain in the left iliac fossa and need to take painkillers. In August 2022, three-dimensional pelvic ultrasound in our hospital showed: basic normal uterine cavity shape, left side wall heterogeneity nodular echo 28 mm×26 mm×20 mm with endometrial echo within 11 mm×10 mm×7 mm, suspected cystic focal uterine adenomyosis or ACUM. Laparoscopic exploration was performed. The appearance of the uterus was normal, the left anterior wall and at the anterior and inferior part of round ligament were slightly full. The uterine wall of slightly full was resected, a pale and tough masses were found and resected completely for examination. ACUM was confirmed by pathology. Symptoms disappeared after follow-up surgery. [ABSTRACT FROM AUTHOR]