Accessory Cavitating Uterine Masses/Malformation: An Important Differential in Women With Intractable Dysmenorrhea and Chronic Pelvic Pain Across All Ages
Richa Vatsa, Soniya Dhiman, Vidushi Kulshrestha, Juhi Bharti, Neena MalhotraABSTRACT
Aim
Accessory cavitated uterine malformation or mass (ACUM) is a rare and under‐recognized cause of dysmenorrhea and chronic pelvic pain (CPP). Various diagnostic criteria have been proposed; patients may present with atypical features. This study aimed to describe the clinical presentation, diagnostic challenges, and management outcomes of ACUM.
Methods
Retrospective analysis of prospectively collected data was done at a tertiary care institution over 6 years. All women diagnosed with ACUM were included. Clinical presentation, imaging, preoperative diagnosis, intraoperative picture, and management outcomes were analyzed.
Result
Eighteen women were enrolled. The median age at presentation was 26.5 years (18–46), with 17 in the reproductive age group and one postmenopausal. The median duration of symptoms was 4 years (2 months to 11 years). Dysmenorrhea with prominent pain on one side, localized to the side of the lesion, was the predominant symptom, occurring in 17/18 (94.4%). Of these, 10/18 (55.6%) experienced both CPP and dysmenorrhea, 7/18 (38.9%) had only dysmenorrhea. Only CPP was reported in 1/18 (5.6%), woman with postmenopausal ACUM. On initial 2D‐USG, one case was correctly diagnosed, while 5/18(27.8%) were misdiagnosed as rudimentary horn, 7/18(38.9%) as degenerated fibroid, 4/18(22.2%) as endometrioma, and 1/18(5.6%) as dermoid cyst. Diagnosis was confirmed on further imaging with 3D‐USG or MRI in 11/18 (61.1%) cases. Seventeen women underwent surgical management, with 16/17 had excision, and one postmenopausal woman was treated by laparoscopic aspiration.
Conclusion
ACUM is an important differential of intractable dysmenorrhea or CPP, especially if pain is localized to either side, even in postmenopausal females.