Background: Accessory Cavitated Uterine Malformation (ACUM) is a rare Müllerian anomaly characterised by a non-communicating, endometrium-lined cavity within an otherwise normally formed uterus. Because external uterine morphology and menstrual flow often appear normal, ACUM is frequently misdiagnosed as endometriosis, juvenile cystic adenomyoma, or fibroid degeneration. Patients typically present with severe cyclic pelvic pain from adolescence, and symptoms often persist despite conventional medical therapy.
Case Report: A 21-year-old woman presented with progressively worsening dysmenorrhoea, recurrent lower abdominal pain, and irregular menstrual cycles. She had been treated elsewhere for one year as a presumed case of endometriosis, with only partial and temporary relief. On evaluation at our centre, ultrasonography revealed a well-defined hypoechoic lesion (2.3 × 2.6 cm) with a central anechoic cavity (10 × 8 mm) located in the left upper lateral myometrium. MRI findings supported a diagnosis of a cavitated myometrial lesion compatible with ACUM. In view of persistent symptoms despite prolonged medical therapy, surgical excision was performed. Gross pathology showed multiple soft-tissue fragments containing an intramyometrial cavity. Microscopy demonstrated an endometrial-lined cavity with haemosiderin-laden macrophages and a surrounding myometrial wall, confirming ACUM. Clinical presentation, imaging, and histopathology together established the diagnosis.
Conclusion: This case underscores the need to consider ACUM in young women with refractory dysmenorrhoea, abdominal pain, or symptoms unresponsive to endometriosis treatment. Early recognition with appropriate imaging and confirmatory histopathology facilitates timely surgical management, which remains curative and significantly improves quality of life.
International Journal of Clinical Obstetrics and Gynaecology
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