Accessory Cavitated Uterine Mass: A Diagnostic Dilemma and Its Laparoscopic Management

Background: Accessory cavitated uterine mass (ACUM) is an uncommon, non-communicating uterine abnormality often misdiagnosed as endometriosis or a rudimentary horn due to overlapping clinical and radiological features.It typically affects young women and presents with dysmenorrhea, chronic pelvic pain, and occasionally infertility.Objective: To highlight three instances of ACUM through a case series approach in patients who underwent successful laparoscopic management, and to highlight the diagnostic challenges, surgical findings, and outcomes of the same.Cases: We report three cases of young females in the age-group of 15-31 years presenting with severe dysmenorrhea and/or infertility.Imaging studies initially suggested endometriosis or cystic uterine lesions.Diagnostic laparoscopy revealed isolated, cavitated uterine masses mostly close to the insertion of the round ligament, separate from the normal cavity of the uterus.All cases were managed by laparoscopic excision.Histopathology confirmed endometrial-lined cavities without features of adenomyosis.Postoperative outcomes were favorable with complete pain resolution and no recurrence.Conclusion: Accessory cavitated uterine mass should be considered in young patients presenting with intractable dysmenorrhea and atypical uterine lesions.Magnetic resonance imaging (MRI) and 3D ultrasound enhance diagnostic accuracy, but laparoscopy remains a definitive diagnostic and therapeutic tool.Complete laparoscopic excision is curative and provides significant symptomatic relief with good reproductive outcomes.