Case Report

Pelvic Pain and Adnexal Mass: Be Aware of Accessory and Cavitated Uterine Mass

Table 1

Summary of previously reported cases of ACUM regarding their clinical features and management.

ReferenceAge at diagnosis (years)SymptomsPreliminary diagnosisType of operation

Present study(a) 14(a) Chronic pelvic pain for two yearsPara-ovarian mass or myomaLaparotomy
Supermaniam et al. [15](a) 22
(b) 36
(a) A 3-month history of severe pain after menses
(b) Chronic pelvic pain and severe dysmenorrhea since menarche
(a) Endometrioma or unicornuate uterus with a noncommunicating rudimentary horn
(b) ACUM or degenerating fibroid
(a, b) Laparoscopy
Paul et al. [2](a) 19
(b) 17
(c) 25
(a) Chronic lower abdominal pain and severe dysmenorrhea for 4 years
(b) Dysmenorrhea for 2 years
(c) Dysmenorrhea for 7 years
(a) Uterine bicornis with a right horn hematometra
(b) N/A
(c) An obstructed rudimentary horn
(a, b, c) Laparoscopy
Bedaiwy et al. [16](a) 16(a) Severe dysmenorrhea and cyclic pelvic pain since menarcheRudimentary horn or cystic adenomyosisLaparoscopy
Jain et al. [17](a) 19
(b) 22
(a) Severe dysmenorrhea and menorrhagia for the last three months
(b) Severe dysmenorrhea, menorrhagia and secondary infertility for two years
(a) Uterus bicornis with a hematometra in obstructed rudimentary horn
(b) Broad ligament fibroid
(a, b) Laparoscopy
Acien et al. [9](a) 15
(b) 21
(c) 33
(d) 32
(e) 48
(a) Severe, right hypogastric pain recurrent for more than one year
(b) Severe dysmenorrhea and hypogastric pain for the past three years
(c) Daily right iliac fossa pain during the previous few months
(d) Intense dysmenorrhea, dyspareunia, right iliac fossa pain, and hypermenorrhea
(e) Severe pain and hypermenorrhea
(a) Rudimentary uterine horn with an endometrial cavity containing thick endometrium
(b) Cavitated adenomyoma
(c) Subserous myoma
(d) Endometrioma
(e) Multiple myoma and cavitated adenomyoma
(a, b) Laparotomy
(c) Laparoscopy
(d) N/A
(e) Total hysterectomy
Acien et al. [4](a) 36
(b) 20
(c) 18
(d) 19
(a) Abdominal pain (more intense in the left iliac fossae and increased during menstruation)
(b) An 8-month history of left iliac fossae pain and progressive dysmenorrhea
(c) Left iliac fossae pain, hypogastric pain, and progressive dysmenorrhea
(d) Pelvic pain and progressive dysmenorrhea with increased pain following menstruation
(a) Degenerated leiomyoma or cystic adenomyoma
(b) Accessory cavitated mass with the appearance of an endometrioma
(c) Cystic adenomyosis
(d) Myoma like structure
(a) Abdominal hysterectomy
(b) Laparotomy with tumorectomy
(c, d) Laparotomy
Na et al. [11](a) 39(a) Continuous abdominal pain in the right lower quadrant (with radiation to the right thigh)Ovarian endometriosisLaparoscopy
Takeuchi et al. [18](a) 30
(b) 29
(c) 27
(d) 20
(e) 30
(f) 28
(g) 23
(h) 20
(i) 20
(a) Pelvic pain
(b) Pelvic pain and dyspareunia
(c) Dyspareunia
(d) Pelvic pain
(e) N/A
(f) Dyspareunia
(g) Pelvic pain
(h) Pelvic pain
(i) Pelvic pain
Cystic adenomyoma(a–i) Laparoscopic tumor enucleation

N/A, not available; ACUM, accessory and cavitated uterine mass.