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Bolocan VO, Diaconu GF, Giuvelea A, Secareanu M, Medar C, Manolescu LS, Petrescu A, Jinga V. Imaging Aspects in a Case of Persistent Müllerian Duct Syndrome (PMDS): A Case Report and Overview. Cureus 2024; 16:e65880. [PMID: 39219885 PMCID: PMC11364497 DOI: 10.7759/cureus.65880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Persistent Müllerian duct syndrome (PMDS) is a rare kind of internal male pseudohermaphroditism. The patient, who has a male karyotype and phenotypic characteristics, exhibits Müllerian duct derivatives such as the uterus, cervix, fallopian tubes, and upper two-thirds of the vagina. This article provides a comprehensive analysis of the CT and MRI characteristics of a case of PMDS in a 35-year-old male patient who sought medical attention at our clinic due to pain in the left inguinal region and the presence of undescended testes on both sides. The imaging results showed a pelvic mass with a bicornuate appearance, situated adjacent to the bladder on the left side. The diagnosis of compensated hypergonadotropic hypogonadism with a normal male karyotype is confirmed through biological and genetic studies. The final diagnosis was confirmed through histopathological examination following laparoscopic transperitoneal surgical removal. The examination revealed a left lateral vesical pelvic tumor with a firm-elastic, bicornuate appearance, along with a thickened endometrium. Microscopic findings included simple glandular hyperplasia with edema in the endometrium, a small adenomatous polyp at the uterine fundus, and bilateral rigid cords consistent with vas deferens histology. The primary issue with PMDS is in its rarity, which consequently limits the availability of comprehensive case series and prospective research. As a result, radiologists and surgeons must possess knowledge of this ailment, as there is a scarcity of defined treatment guidelines and long-term care strategies.
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Affiliation(s)
- Vlad-Octavian Bolocan
- Department of Clinical Laboratory of Radiology and Medical Imaging, Clinical Hospital "Prof. Dr. Theodor Burghele", Bucharest, ROU
- Department of Fundamental Sciences, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Georgian-Florentin Diaconu
- Department of Clinical Laboratory of Radiology and Medical Imaging, Clinical Hospital "Prof. Dr. Theodor Burghele", Bucharest, ROU
| | - Alexandra Giuvelea
- Department of Clinical Laboratory of Radiology and Medical Imaging, Clinical Hospital "Prof. Dr. Theodor Burghele", Bucharest, ROU
| | - Mihaela Secareanu
- Department of Clinical Laboratory of Radiology and Medical Imaging, Clinical Hospital "Prof. Dr. Theodor Burghele", Bucharest, ROU
| | - Cosmin Medar
- Department of Clinical Laboratory of Radiology and Medical Imaging, Clinical Hospital "Prof. Dr. Theodor Burghele", Bucharest, ROU
- Department of Fundamental Sciences, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Loredana S Manolescu
- Department of Fundamental Sciences, Faculty of Midwifery and Nursing, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
| | - Amelia Petrescu
- Department of Pathology, Clinical Hospital "Prof. Dr. Theodor Burghele", Bucharest, ROU
| | - Viorel Jinga
- Department of Urology, Clinical Hospital "Prof. Dr. Theodor Burghele", Bucharest, ROU
- Department of Urology, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", Bucharest, ROU
- Medical Sciences Section, Academy of Romanian Scientists, Bucharest, ROU
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Clinical spectrum of female genital malformations in prenatal diagnosis. Arch Gynecol Obstet 2022; 306:1847-1862. [DOI: 10.1007/s00404-022-06441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Introduction
Fetal genital malformations represent a rare and heterogeneous group of congenital malformations of the disorders of sexual development (DSD) spectrum.
Methods
A thorough literature review on the main topics in the prenatal approach towards DSD was conducted.
Results
First, a thorough overview on prenatal characteristics of the most common fetal genital malformations of ovaries, uterus and external genitalia, and second, a standardized approach for differential diagnosis in the presence of direct and indirect prenatal signs of DSDs.
Conclusions
This review is mainly directed towards the aspects of female genital malformations with aspects of male DSD explained as well to aid in the prenatal differential diagnosis.
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Soto ÁL, González MB, Reyes IU, Meseguer González JL, Pérez MÁJ, Izquierdo OG. Fetal sex discordance. Taiwan J Obstet Gynecol 2021; 59:652-655. [PMID: 32917312 DOI: 10.1016/j.tjog.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2020] [Indexed: 12/01/2022] Open
Abstract
Fetal sex discordance is an entity that is becoming more frequent due to the expansion of the cfDNA for prenatal diagnosis. Its incidence can be estimated in 1/1500-2000 pregnancies, a frequency as high as that of some common chromosomopathies. The causes of this phenomenon are multiple and diverse, ranging from laboratory errors to important pathologies such as disorders of sexual differentiation. The management of a case of fetal sex discordance must be structured, starting with the review of the clinical history and the tests performed, and may require the performance of invasive tests to reach a diagnosis. Prevention through adequate pretest counseling and ultrasound confirmation can help to reduce its incidence.
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Affiliation(s)
- Álvaro López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain.
| | - Mar Bueno González
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain
| | - Isabel Urbano Reyes
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain
| | | | - M Ángeles Jódar Pérez
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain
| | - Olivia García Izquierdo
- Prenatal Diagnosis Unit, Department of Obstetrics, Hospital General Santa Lucía, Cartagena, Spain
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Yoshii K, Naiki Y, Terada Y, Fukami M, Horikawa R. Mismatch between fetal sexing and birth phenotype: a case of complete androgen insensitivity syndrome. Endocr J 2018; 65:221-225. [PMID: 29118296 DOI: 10.1507/endocrj.ej17-0289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
With advancing maternal age, the number of prenatal genetic tests is increasing in many countries. Prenatal genetic tests, such as amniocentesis, chorionic villus sampling and non-invasive prenatal testing, can disclose fetal chromosomal sex, although these tests were originally designed to prenatally diagnose chromosomal aneuploidies, such as trisomy 21, 18 and 13. Complete androgen insensitivity syndrome (CAIS) is an X-linked recessive disorder caused by an androgen receptor dysfunction leading to hormone resistance. The affected individuals are genetic males as shown by 46,XY but present complete female external genitalia and normal breast development at puberty albeit without menstruation. CAIS is commonly diagnosed in adolescence based on primary amenorrhea or in childhood based on inguinal hernia or testis-like masses in the inguinal region. In the present report, we describe a baby in whom CAIS was diagnosed immediately after birth based on a mismatch between the fetal karyotype detected by amniocentesis and the external genitalia phenotype at birth. We speculate that the increase in the number of prenatal genetic tests is contributing to the early detection of 46,XY disorders of sex development, especially those previously called complete sex reversal, which is supposedly diagnosed during childhood or adolescence. Hence, it is necessary to understand the disease-specific hormone profile at each developmental stage for accurate diagnosis.
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Affiliation(s)
- Keisuke Yoshii
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Yasuhiro Naiki
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Yumiko Terada
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Reiko Horikawa
- Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
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Discordant Embryonic Aneuploidy Testing and Prenatal Ultrasonography Prompting Androgen Insensitivity Syndrome Diagnosis. Obstet Gynecol 2015; 125:383-386. [DOI: 10.1097/aog.0000000000000503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
Abstract
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Raga F, Bonilla F, Bonilla-Musoles F, Castillo JC. 3D, Vocal and Tomographic Ultrasound Image in Prenatal Diagnosis of Hypospadias. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10009-1217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
We report a case of anterior hypospadias, diagnosed at 26th week in a 37 years-old primigravida with normal 46XY kariotype through amniocentesis carried out at 16th week.
Sonographic examination with 2D showed a short and curved penis. The use of three orthogonal planes, Tomographic Ultrasound Image (TUI) and VOCAL allowed an exact prenatal diagnostic, showing the “tulip” sign and defining localization, situation and extension of the urethral orifice.
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Affiliation(s)
- Lisa Allen
- Pediatric Gynecology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Yalinkaya A, Yayla M, Erdemoglu M. Prenatal diagnosis of a fetus with androgen insensitivity syndrome (AIS). Prenat Diagn 2007; 27:856-7. [PMID: 17605153 DOI: 10.1002/pd.1747] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study is to describe a fetus with androgen insensitivity syndrome diagnosed at mid-second trimester. CASE AND METHODS Nuchal translucency was measured thick and double test was found higher. The patient referred to our center at 16(th) weeks of gestation. Fetal ultrasound examination and amniocentesis was performed. RESULTS The nuchal translucency (NT) of fetus in present pregnancy was measured approximately 10 mm at 13 weeks and Down syndrome risk was calculated 1 in 10 by double test. On ultrasound examination; thick nuchal fold (NF) and short fetal limbs were found, and the fetus was seen a female and amniocentesis was performed. Three weeks later the fetal karyotype was reported normal as 46,XY. Thereupon the fetus reexamined for 2D and 4D ultrasound, and confirmed previous findings. The fetus was terminated at 19(th) weeks and seen a female phenotype. The fetal gonads removed in abdomen and testicles confirmed histopatologically. CONCLUSION In generally, diagnosis of AIS is most made postnatally. This is the second case in English literature, which diagnosed mid-second trimester. In this situation, the fetus with thick NT/NF and short limbs may be AIS, therefore appearance of fetal sex on ultrasound should be compared with genetic sex.
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Affiliation(s)
- Ahmet Yalinkaya
- Dicle University School of Medicine, Gynecology and Obstetrics, Turkey.
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Riskin A, Koren I, Bader D, Grün M, Dar H, Leibovitz Z, Kugelman A, Hiort O. The approach to a neonate with a possible prenatal diagnosis of androgen insensitivity syndrome. J Pediatr Endocrinol Metab 2006; 19:1437-43. [PMID: 17252697 DOI: 10.1515/jpem.2006.19.12.1437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The diagnosis of androgen insensitivity syndrome (AIS) can now be made prenatally. We present a patient for whom the diagnosis of AIS was highly suspected prenatally, but the parents preferred to deny it. The clinical findings and the diagnostic evaluation after delivery are presented. A brief discussion of the syndrome, as well as the implications of possible prenatal diagnosis and how to approach it, are provided. Full multidisciplinary diagnostic work-up immediately after delivery, as well as awareness of possible prenatal diagnosis, is the responsibility of the primary care provider for the newborn with suspected AIS.
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Affiliation(s)
- Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, B. Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
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