European Radiology

, Volume 29, Issue 3, pp 1144–1152 | Cite as

Accessory cavitated uterine mass: MRI features and surgical correlations of a rare but under-recognised entity

  • N. Peyron
  • E. Jacquemier
  • M. Charlot
  • M. Devouassoux
  • D. Raudrant
  • F. Golfier
  • P. RoussetEmail author



To describe MRI features of accessory cavitated uterine mass (ACUM) with surgical correlations.


Eleven young women with an ACUM at pathology underwent preoperative pelvic MRI. Two experienced radiologists retrospectively analysed MR images in consensus to determine the lesion location within the uterus, its size, morphology (shape and boundaries), and structure reporting the signal and enhancement of its different parts compared to myometrium. The presence of an associated urogenital malformation or other gynaecological anomaly was reported. MRI features were correlated with surgical findings.


All 11 lesions were well correlated with surgical findings, lateralised (seven were left-sided), and located under the horn and the round ligament insertion. Nine were located within the external myometrium, bulging into the broad ligament. Two were extrauterine, entirely located within the broad ligament. On MRI, the mean size was 28 mm (range 17–60 mm). Nine lesions were round-shaped, two were oval; all had regular boundaries. At surgery, the ACUM were not encapsulated but were possible to enucleate. On MRI, all lesions were well defined and showed a central haemorrhagic cavity surrounded by a regular ring (mean thickness, 5 mm) which had the same signal compared to the junctional zone. ACUM was isolated in all women, without urogenital malformation, adenomyosis or deep endometriosis.


On MRI, ACUM was an isolated round accessory cavitated functional non-communicating horn-like aspect in an otherwise normal uterus. MRI may facilitate timely diagnosis and appropriate curative fertility-sparing laparoscopic resection.

Key Points

• ACUM is rare, with delayed diagnosis in young women with severe dysmenorrhoea. Pelvic MRI facilitates timely diagnosis and appropriate curative fertility-sparing laparoscopic resection.

• Quasi-systematically located under the uterine round ligament insertion, ACUM may be intramyometrial and/or in the broad ligament.

• On MRI ACUM resemble a non-communicating functional accessory horn within a normal uterus; the mass, most often round-shaped, had a central haemorrhagic cavity surrounded by a regular ring which had the same low signal compared to the uterine junctional zone.


Uterine anomalies Magnetic resonance imaging Dysmenorrhoea Pelvic pain Adenomyosis 



Accessory cavitated uterine mass


European Society of Human Reproduction and Embryology


European Society for Gynaecological Endoscopy


Field of view


Magnetic resonance


Magnetic resonance imaging


Oestrogen receptor


Progesterone receptor


Section thickness


Echo time


Repetition time



The authors would like to thank Philip Robinson (DRCI, Hospices Civils de Lyon) for help in manuscript preparation.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Professor Pascal Rousset, Lyon, France.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.


• retrospective

• observational

• performed at one institution

Supplementary material

330_2018_5686_MOESM1_ESM.docx (5.1 mb)
ESM 1 (DOCX 5261 kb)


  1. 1.
    Oliver J (1912) An accessory uterus distended with menstrual fluid enucleated from the substance of the right broad ligament. Lancet 179:1609CrossRefGoogle Scholar
  2. 2.
    Kataoka ML, Togashi K, Konishi I et al (1998) MRI of adenomyotic cyst of the uterus. J Comput Assist Tomogr 22:555–559CrossRefGoogle Scholar
  3. 3.
    Takeda A, Sakai K, Mitsui T, Nakamura H (2007) Laparoscopic management of juvenile cystic adenomyoma of the uterus: report of two cases and review of the literature. J Minim Invasive Gynecol 14:370–374CrossRefGoogle Scholar
  4. 4.
    Ho ML, Raptis C, Hulett R, McAlister WH, Moran K, Bhalla S (2008) Adenomyotic cyst of the uterus in an adolescent. Pediatr Radiol 38:1239–1242CrossRefGoogle Scholar
  5. 5.
    Takeuchi H, Kitade M, Kikuchi I, Kumakiri J, Kuroda K, Jinushi M (2010) Diagnosis, laparoscopic management, and histopathologic findings of juvenile cystic adenomyoma: a review of nine cases. Fertil Steril 94:862–868CrossRefGoogle Scholar
  6. 6.
    Kriplani A, Mahey R, Agarwal N, Bhatla N, Yadav R, Singh MK (2011) Laparoscopic management of juvenile cystic adenomyoma: four cases. J Minim Invasive Gynecol 18:343–348CrossRefGoogle Scholar
  7. 7.
    Liang YJ, Hao Q, Wu YZ, Wu B (2010) Uterus-like mass in the left broad ligament misdiagnosed as a malformation of the uterus: a case report of a rare condition and review of the literature. Fertil Steril 93:1347.e13–1347.e16CrossRefGoogle Scholar
  8. 8.
    Potter DA, Schenken RS (1998) Non communicating accessory uterine cavity. Fertil Steril 70:1165–1166CrossRefGoogle Scholar
  9. 9.
    Acién P, Acién M, Fernández F, José Mayol M, Aranda I (2010) The cavitated accessory uterine mass: a Müllerian anomaly in women with an otherwise normal uterus. Obstet Gynecol 116:1101–1109CrossRefGoogle Scholar
  10. 10.
    Acién P, Bataller A, Fernández F, Acién MI, Rodríguez JM, Mayol MJ (2012) New cases of accessory and cavitated uterine masses (ACUM): a significant cause of severe dysmenorrhea and recurrent pelvic pain in young women. Hum Reprod 27:683–694CrossRefGoogle Scholar
  11. 11.
    Acién P, Sánchez del Campo F, Mayol MJ, Acién M (2011) The female gubernaculum: role in the embryology and development of the genital tract and in the possible genesis of malformations. Eur J Obstet Gynecol Reprod Biol 159:426–432CrossRefGoogle Scholar
  12. 12.
    Acién P, Acién MI (2011) The history of female genital tract malformation classifications and proposal of an updated system. Hum Reprod Update 17:693–705CrossRefGoogle Scholar
  13. 13.
    Bedaiwy MA, Henry DN, Elguero S, Pickett S, Greenfield M (2013) Accessory and cavitated uterine mass with functional endometrium in an adolescent: diagnosis and laparoscopic excision technique. J Pediatr Adolesc Gynecol 26:e89–e91CrossRefGoogle Scholar
  14. 14.
    Jain N, Verma R (2014) Imaging diagnosis of accessory and cavitated uterine mass, a rare mullerian anomaly. Indian J Radiol Imaging 24:178–181CrossRefGoogle Scholar
  15. 15.
    Paul PG, Chopade G, Das T, Dhivya N, Patil S, Thomas M (2015) Accessory cavitated uterine mass: a rare cause of severe dysmenorrhea in young women. J Minim Invasive Gynecol 22:1300–1303CrossRefGoogle Scholar
  16. 16.
    Peters A, Rindos NB, Guido RS, Donnellan NM (2018) Uterine-sparing laparoscopic resection of accessory cavitated uterine masses. J Minim Invasive Gynecol 25:24–25CrossRefGoogle Scholar
  17. 17.
    World Health Organization (2003) World Health Organization classification of tumours: pathology and genetics of tumours of the breast and female genital organs. World Health Organization, Geneva Accessed 10 Jul 2018Google Scholar
  18. 18.
    Behr SC, Courtier JL, Qayyum A (2012) Imaging of mullerian duct anomalies. Radiographics 32:E233–E250CrossRefGoogle Scholar
  19. 19.
    Grimbizis GF, Di Spiezio Sardo A, Saravelos SH et al (2016) The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 31:2–7Google Scholar
  20. 20.
    Munro MG, Critchley HO, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders (2011) FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 113:3–13CrossRefGoogle Scholar
  21. 21.
    Lakhman Y, Veeraraghavan H, Chaim J et al (2017) Differentiation of uterine leiomyosarcoma from atypical leiomyoma: diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis. Eur Radiol 27:2903–29152CrossRefGoogle Scholar
  22. 22.
    Hall-Craggs MA, Williams CE, Pattison SH, Kirkham AP, Creighton SM (2013) Mayer-Rokitansky-Kuster-Hauser syndrome: diagnosis with MR imaging. Radiology 269:787–792CrossRefGoogle Scholar
  23. 23.
    Grimbizis GF, Gordts S, Di Spiezio Sardo A et al (2013) The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 28:2032–2044CrossRefGoogle Scholar
  24. 24.
    Parazzini F, Vercellini P, Panazza S, Chatenoud L, Oldani S, Crosignani PG (1997) Risk factors for adenomyosis. Hum Reprod 12:1275–1279CrossRefGoogle Scholar
  25. 25.
    Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, Koyama T (2005) MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 25:21–40CrossRefGoogle Scholar
  26. 26.
    Bazot M, Daraï E (2018) Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril 109:389–397CrossRefGoogle Scholar
  27. 27.
    Chamié LP, Blasbalg R, Pereira RM, Warmbrand G, Serafini PC (2011) Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics 31:E77–E100CrossRefGoogle Scholar
  28. 28.
    Bazot M, Deux JF, Dahbi N, Chopier J (2001) Myometrium diseases. J Radiol 82:1819–1840Google Scholar
  29. 29.
    Moyle PL, Kataoka MY, Nakai A, Takahata A, Reinhold C, Sala E (2010) Nonovarian cystic lesions of the pelvis. Radiographics 30:921–938CrossRefGoogle Scholar
  30. 30.
    Protopapas A, Milingos S, Markaki S et al (2008) Cystic uterine tumors. Gynecol Obstet Invest 65:275–280CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Radiology DepartmentLyon Sud University Hospital, Hospices Civils de LyonPierre BéniteFrance
  2. 2.Pathology DepartmentLyon Sud University Hospital, Hospices Civils de LyonLyonFrance
  3. 3.Lyon 1 Claude Bernard UniversityLyonFrance
  4. 4.Gynaecology and Obstetrics DepartmentLyon Sud University Hospital, Hospices Civils de LyonLyonFrance

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