Accessory Cavitated Uterine Mass: A Diagnostic Dilemma Illustrated by Three Case Reports

Accessory cavitated uterine mass (ACUM) is a rare, unclassified Müllerian anomaly characterized by distinct imaging features. It is typically located within the uterus, close to the round ligament, and has a uterus-like structural arrangement. The patient may present with pelvic pain or dysmenorrhea. Most of these cases are misdiagnosed because of a lack of awareness about this unusual entity.

Three cases of ACUM in young patients who experienced prolonged symptoms and had incomplete family structures were reported in this paper. Initially, two of these cases were misdiagnosed during ultrasound examinations (USG). The subsequent magnetic resonance imaging (MRI) revealed characteristic imaging features consistent with ACUM, which provided significant psychological relief to both the patients and their families. Two patients received hormonal therapy, both of whom were unmarried. The third patient, however, indicated a wish to conceive and was therefore initiated on analgesics. All three patients chose to forgo surgical intervention, opting instead for medical management despite its limited success in alleviating their symptoms. This decision was made to minimize obstetric risks associated with surgical interventions in potential future pregnancies.

Laparoscopy or open surgery is the mainstay treatment for a permanent relief from the symptoms. However, surgical treatment should be offered with caution as no data are available in medical literature regarding the effect of surgically induced myometrial scarring on patients' reproductive outcomes. Since most of these patients were young and nulligravida, the therapy had to be personalized in accordance with the patient's preference and family status.