Differential diagnosis and management tactics in patients with a rare developmental Mtillerian duct anomaly ACUM and a rudimentary uterine horn at early reproductive age


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Abstract

Background. There has recently been a 10-fold increase in the detection rate of genital malformations in girls. Accessory and Cavitated Uterine Mass (ACUM) is one of the rare forms of developmental Mullerian duct anomaly, is more common in adolescents and is an isolated accessory uterine cavity in a normal uterus. The paper summarizes the currently available data on the clinical features and differential diagnosis of ACUM and a double uterus with a rudimentary uterine horn, as well as nodular adenomyosis. Due to the typical clinical presentation and the rarity of ACUM, the patients are often diagnosed with genital malformation and a complete uterine duplication in the presence of a functioning uterine rudiment or nodular adenomyosis. Some authors believe that ACUM and juvenile cystic adenomyoma are the same structure that results from gubernacular dysfunction. The differential instrumental diagnosis of ACUM is of great importance. The paper presents the main criteria for visualization of ACUM, uterine rudiment, and nodular adenomyosis according to pelvic ultrasound and MRI. An example of differential diagnosis and management is analyzed in a series of clinical cases in adolescent patients with developmental Mullerian duct anomaly (ACUM) and a rudimentary uterine horn. Conclusion. The described clinical cases emphasize the importance of imaging methods in the differential diagnosis of ACUM and uterine rudiment, as well as the need for timely surgical intervention for mass removal and metroplasty.

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About the authors

Elena P. Khashchenko

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: khashchenko_elena@mail.ru
PhD, Senior Researcher of the 2nd Gynecological (children and adolescent) Department

Elvina Z. Allakhverdieva

M.V. Lomonosov Moscow State University

Email: elya.elya2014@mail.ru
student of Faculty of Fundamental Medicine

Alek S. Arakelyan

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: _arakelyan@oparina4.ru
PhD, Senior Researcher of the Gynecological Department

Elena V. Uvarova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University) Ministry of Health of the Russian Federation

Email: elena-uvarova@yandex.ru
Dr. Med. Sci., Professor, Corresponding Members of the RAS, Head of 2nd Gynecological (children and adolescent) Department

Vladimir D. Chuprynin

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: v_chuprynin@oparina4.ru
PhD, Head of General Surgery department

Elena A. Kulabukhova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: e_kulabukhova@oparina4.ru
PhD, radiologist at the Department of Radiation Diagnostics

Irina A. Luzhina

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: i_luzhina@oparina4.ru
radiologist at the Department of Radiation Diagnostics

Polina V. Uchevatkina

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: uchevatkina@oparina4.ru
Doctor of Department of Radiation Diagnostics

Fatima Sh. Mamedova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation; Russian Medical Academy of Continuing Professional Education, Ministry of Health of the Russian Federation

Email: mamedova_f@mail.ru
PhD, Doctor of Department of Ultrasound Diagnostics in Neonatology and Pediatrics

Aleksandra V. Asaturova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: a_asaturova@oparina4.ru
PhD, Head of 1th Pathology Department

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