Functional müllerian tissue within the conus medullaris generating cyclical neurological morbidity in an otherwise healthy female

Müllerianosis of the urinary bladder with unilateral complete renal agenesis: a rare coincidental finding causing delayed presentation

Müllerianosis is a rare benign lesion of the urinary bladder, which is constituted by two or more of the Müllerian-duct-derived tissues. We report a 45-year-old perimenopausal multiparous woman presenting with occasional episodes of dysuria and lower abdominal discomfort of recent duration. Ultrasound examination revealed a well-defined lesion in urinary bladder and the absence of left kidney. Contrast-enhanced CT of the abdomen confirmed the findings. During diagnostic cystoscopy, haemorrhagic polypoidal lesions were noted in the left side of the posterolateral wall and dome of urinary bladder along with the absence of left ureteric orifice. Transurethral resection of the bladder lesions was done and histology examination confirmed the diagnosis of Müllerianosis. She was administered Luteinizing hormone-releasing hormone (LHRH) agonist monthly. At 1 year of follow-up, cystoscopy showed only scar tissue. The case was reported for the rarity of Müllerianosis noted in a patient with unilateral agenesis of kidney, a possible cause of delayed presentation.

Perineural Spread of Clear Cell Adenocarcinoma of Müllerian Origin Resulting in Neoplastic Lumbosacral Plexopathy

BACKGROUND

Adenocarcinomas of müllerian origin are malignancies derived from tissues of the proximal third of the vagina, cervix, uterus, and fallopian tubes. These organs develop from the embryologic müllerian ducts. While reports of perineural spread of certain uterine and cervical carcinomas exist in the literature, to our knowledge, no reports of clear cell-type müllerian adenocarcinoma presenting with neural invasion of the lumbosacral plexus exist in the literature.

CASE DESCRIPTION

A 77-year-old woman with a remote history of hysterectomy and bilateral salpingo-oopherectomy for benign disease presented for evaluation of foot drop. We present clinical, electromyographic, and imaging findings of her condition, which revealed a diffuse intraneural lesion of the ipsilateral lumbosacral plexus. Percutaneous biopsy of the lesion confirmed nerve infiltrating clear cell adenocarcinoma of müllerian origin.

CONCLUSIONS

We present the first case of adenocarcinoma of müllerian origin with confirmed perineural spread presenting with ipsilateral lower extremity weakness. This case illustrates the importance of recognizing potential perineural spread of gynecologic malignancies to avoid delay in treatment.

The Clinical Anatomy of Endometriosis: A Review

Endometriosis is a gynecological disorder identified by the presence of ectopic endometrial tissue outside the uterus. Largely, it affects reproductive-aged women and is a major cause of infertility. Clinical manifestations of endometriosis include dyspareunia, cyclic menstrual pain, chronic pelvic pain, and dyschezia, all of which can affect the patient's quality of life and health severely; therefore, it is paramount that medical treatment is initiated as soon as endometriosis is suspected clinically. In this review, we examine the known anatomic principles of endometriosis in the literature and outline ways to manage patients with this condition better.

Müllerianosis of the urinary bladder: a rare and problematic bladder tumour

Müllerianosis of the bladder is an extremely rare and highly symptomatic bladder tumour comprising of at least two types of Müllerian derived tissues. We present the case of a 59-year-old woman presenting with painful macroscopic haematuria associated with urgency, frequency and incontinence. She is a nulliparous postmenopausal woman without malignancy risk factors or previous abdominal surgery. Initially identified on ultrasound scan, she was taken for transurethral resection of bladder tumour (TURBT). Histology confirms the diagnosis. Repeat TURBT was required for non-resolution of symptoms. Despite a thorough resection, symptoms recurred within months necessitating partial cystectomy. Although a 'benign' lesion, this lesion proved a difficult condition to treat requiring partial cystectomy.

Florid Cystic Endosalpingiosis (Müllerianosis) in Pregnancy

Cystic endosalpingiosis refers to the existence of heterotopic cystic müllerian tissue resembling structures of the fallopian tubes. We report a case of florid cystic endosalpingiosis discovered in a pregnant woman during a scheduled cesarean section and review the current knowledge of this disease. A 30-year-old woman with a twin pregnancy attended the hospital day unit at term. The first twin was in a breech presentation and a cesarean section was scheduled. During the procedure the uterine fundus and part of the body were seen completely seeded with multitude of cyst-like structures resembling hydatids of Morgagni. The immunohistochemistry analysis showed a positive expression for PAX8 (Box-8), CK7, and estrogen and progesterone receptors. The lesions did not disappear after pregnancy. Cystic endosalpingiosis should be always borne in mind, even in pregnancy, when it comes to making the differential diagnosis of a pelvic or systemic multicystic mass.