Sonografic features of accessory cavitated uterine mass (ACUM) successfully treated with robotic assisted laparoscopic surgery- a case report

Abstract

A 24-year-old 0-para presented to our department with a history of severe dysmenorrhea and pelvic pain refractory to intensified analgesia and continuous hormonal contraceptive treatment. She underwent expert 2D-and 3D-ultrasound assessment. We used transvaginal (TVU) and transrectal ultrasound (TRU). We found a thick-walled cystic lesion with hypoechoic to ground-glass content, protruding from the right lateral uterine wall below the insertion of the round ligament. There were no signs of adenomyosis or deep invasive endometriosis (DIE). No other pathologies or anatomical anomalies were found on ultrasound or magnetic resonance imaging (MRI). The mass was highly suggestive of ACUM given its morphology, the normally shaped uterine cavity and the absence of adenomyotic features. Due to failure of conservative treatment and ongoing severe interval pain the patient was scheduled for uterine-sparing robotic assisted laparoscopic surgery. The postoperative recovery was uneventful and the woman reported substantial symptom relief at the 3-months follow-up visit. Pathologic analysis suggested ACUM and no histological features of adenomyosis were found. We believe that ACUM is a diagnosis that is not commonly known. TVU or TRU are non-invasive and costeffective examination techniques to evaluate congenital uterine malformations. Robotic assisted laparoscopic surgery is a safe and feasible way to treat this condition.