Revisiting the diagnostic criteria and surgical management of an accessory cavitated uterine mass (ACUM).
Academic Article
Overview
abstract
OBJECTIVE: To clarify the diagnostic criteria of an accessory cavitated uterine mass (ACUM) and to describe the clinical presentation, diagnosis, and surgical management of two patients with an ACUM. DESIGN: Video presentation describing the diagnostic and surgical management of an ACUM. SETTING: Academic hospital setting. PATIENTS: Two patients who presented with severe unilateral pelvic pain secondary to an ACUM. INTERVENTIONS: Laparoscopic excision of the ACUM. MAIN OUTCOME MEASURES: Diagnostic criteria to identify an ACUM and surgical techniques to safely excise the rare mass. RESULTS: We present two clinical cases of patients diagnosed with an ACUM. The patients included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites, and other applicable sites. Case 1 is a 14-year-old female with a history of severe right-sided dysmenorrhea who was admitted for management of acute right lower quadrant abdominal pain. She was diagnosed with an ACUM located on the right anterior aspect of the uterus on magnetic resonance imaging (MRI) of the pelvis. She underwent a laparoscopic excision of the ACUM during her hospital admission. Case 2 is a 23-year-old female who presented to clinic with cyclic lower left-sided pain. She was initially diagnosed with a left hematosalpinx and was later diagnosed with an ACUM located on the left anterior uterine aspect on MRI. She subsequently underwent a laparoscopic excision of the ACUM at an ambulatory surgical center. CONCLUSIONS: An ACUM is a rare Müllerian anomaly that may present with severe unilateral dysmenorrhea. There are no clear diagnostic criteria; thus, ACUMs are often misclassified in the already scant literature and their diagnosis and management are delayed due to the lack of recognition by clinicians (1,2). We highlight key features of an ACUM and present its newly established diagnostic criteria, which will be incorporated into the American Society of Reproductive Medicine (ASRM) Müllerian Anomalies Classification (MAC) tool version 2 (3). Our goal is to highlight its distinct features from other Müllerian anomalies and guide providers to promptly diagnose and appropriately manage patients with this condition. The surgical techniques presented will help to provide a framework for safe and efficient excision of an ACUM, which is imperative in the management of these patients.
