Accessory and cavitated uterine mass (ACUM) is a rare uterine anomaly comprised of an accessory uterus-like mass in the uterus along the wall but with no communication to the main uterus.
This pathology generally presents at a young age (before 30 years) with pelvic pain and dysmenorrhea.
Many authors consider ACUM a congenital anomaly, however other theories of development including heterotopias and metaplasia exist. The condition is different from cystic adenomyosis where the cysts are usually small and do not have a typical endometrial lining or uterus-like muscle which is seen in ACUM. The main uterus does not show features of adenomyosis but the myometrium of ACUM may show features of adenomyosis.
- accessory cavitated mass along the uterine wall under the round ligament
- normal uterus, fallopian tubes, and ovaries
- blood degradation products in the cavity/cystic part
- no adenomyosis in the main uterus but features of adenomyosis can be seen in ACUM itself
Ultrasound is usually the first investigation. US can demonstrate a solid mass along the uterine wall with a variable cystic component that can resemble an endometrioma.
It can be difficult to differentiate ACUM from a unicornuate uterus with obstructed rudimentary horn. Hysterosalpingography ( HSG ) can help in such cases.
MRI will typically show an accessory cavitated mass along the uterine wall under the round ligament with T2 hyperintense endometrial lining and blood degradation products in the cavity.
It will further demonstrate a normal uterus, cornua, and ovaries which helps rule out other lesions in the region.
Main differential diagnoses include:
- 1. Jain N, Verma R. Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly. (2014) The Indian journal of radiology & imaging. 24 (2): 178-81. doi:10.4103/0971-3026.134411 - Pubmed
- 2. Bedaiwy M, Bedaiwy HD, Bedaiwy ES, Bedaiwy PS, Bedaiwy GM, Bedaiwy. Accessory and cavitated uterine mass with functional endometrium in an adolescent: diagnosis and laparoscopic excision technique. (2013) Journal of pediatric and adolescent gynecology. doi:10.1016/j.jpag.2012.11.003 - Pubmed
- 3. Aci nP, Aci nM, Aci FnF, Aci JMM, Aci AI, Aci. The cavitated accessory uterine mass: a Müllerian anomaly in women with an otherwise normal uterus. (2010) Obstetrics and gynecology. doi:10.1097/AOG.0b013e3181f7e735 - Pubmed