Lessons learned from five patients of persistent Mullerian duct syndrome: A case series

Persistent Mullerian duct syndrome in a male child: A rare case report on the intersection of surgical importance and economic barriers in Syria

INTRODUCTION

During embryology, the Mullerian duct develops later into the female reproductive tract, and it is usually obliterates in males by anti-Mullerian hormone. Mutations in the gene for anti-Mullerian hormone or anti-Mullerian hormone receptor will cause persistent Mullerian duct syndrome. To the best of our knowledge, this is the first case of this syndrome documented in the medical literature from Syria.

PRESENTATION OF CASE

Herein, we report a case of a 3-year-old male with external male genitalia, who presented complaining mainly of urinary tract infection symptoms. The ultrasound showed the presence of both Mullerian and Wolffian duct derivatives. In fact, and unfortunately, the main obstacles to complete further investigations in this case were a lack of cooperation from parents and the costs of these investigations. We hope that this case report will make interesting additions to the medical literature.

DISCUSSION

PMDS syndrome is a rare condition characterized by male pseudohermaphroditism, where individuals have male external features but also possess female reproductive organs. Diagnosis often involves imaging techniques like ultrasound and MRI to visualize Mullerian structures. Laboratory tests, including hormone level assessments, are crucial for confirming the diagnosis. Surgical intervention is the primary treatment approach to prevent complications.

CONCLUSION

The most common presentations for PMDS include inguinal hernia, testicular tumors, cryptorchidism, and abdominal tumors. So, when treating an inguinal hernia, especially if there is cryptorchidism, the possibility of PMDD should be considered. Early diagnosis and investigations play a major role in effective management and prevention the complications of this syndrome.

A rare case report of orchiopexy and hysterectomy in an Afghan boy with persistent Müllerian duct syndrome

INTRODUCTION

Persistent Müllerian duct syndrome (PMDS), a rare genetic aberration, is characterized by the presence of Müllerian duct (MD) features in males. PMDS is usually caused by a defect in the Müllerian inhibitory system and is discovered during surgical interventions.

CASE REPORT

We present the case of a 14-year-old Afghan boy with severe abdominal pain who was initially diagnosed with bilateral undescended testicles and abdominal complex cysts. He was supposed to undergo a cystectomy and orchiopexy surgery. During the surgical intervention, an unexpected finding was made whereby fibrotic-like ovaries, fallopian tubes, and a segment of the uterus were identified, ultimately leading to the diagnosis of PMDS. The MD was carefully removed, and the testicles were delicately repositioned during an orchiopexy procedure.

DISCUSSION

In our case, the patient exhibited bilateral undescended testicles along with fibrotic-like ovaries, fallopian tubes, and a portion of the uterus, representing the presence of the female type of PMDS. To safeguard fertility, orchidopexy is recommended for pediatric patients. Conversely, in the older age group, orchidectomy is advised as a precautionary measure against the heightened susceptibility to testicular carcinoma.

CONCLUSION

PMDS can be associated with an undescended testicle and abdominal pain. Hence, it is crucial to thoroughly evaluate patients who have undescended testes for the presence of PMDS, and surgeons must maintain a heightened sense of awareness for PMDS while exploring individuals who present with bilateral undescended testes, as exemplified in our case.

Persistent Mullerian duct syndrome with polycystic ovary in a young adult: A rare case report

Persistent Mullerian Duct Syndrome (PMDS) is a type of pseudohermaphroditism that occurs in males. It is an autosomal recessive type of familial disease that is commonly associated with a history of consanguinity. We have documented this case of a 22-year-old adult male who came with acute right iliac pain; after an ultrasound scan and hormone investigations, he was diagnosed with polycystic ovarian syndrome (PCOS).