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Jang S, Kim B, K Venkatesh S, T Flicek K. MR imaging of benign vulvar lesions: a pictorial essay. Abdom Radiol (NY) 2024:10.1007/s00261-024-04524-0. [PMID: 39180666 DOI: 10.1007/s00261-024-04524-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/06/2024] [Accepted: 08/10/2024] [Indexed: 08/26/2024]
Abstract
Benign vulvar lesions can be difficult to differentiate with few publications on their imaging appearances. While many vulvar lesions may be clinically diagnosed and treated, more are being detected incidentally with the increasing prevalence of magnetic resonance imaging (MRI) of the pelvis. In addition, clinicians may find imaging of benign vulvar lesions helpful for greater anatomical correlation. After reviewing the important MRI sequences for vulvar imaging and the anatomy of the vulva on MRI, this pictorial essay illustrates variety of cystic and solid benign vulvar lesions to familiarize radiologists with their common MRI appearances. Other miscellaneous pelvic lesions that can affect the vulva are also described.
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Katabathina VS, Ghannam S, Chen M, Desalme B, Gabos R, Emejulu I, Sandhu PK, Valente P, Dasyam AK, Prasad SR. Update on Pathologic Conditions, Imaging Findings, Prevention, and Management of Human Papillomavirus-related Neoplasms. Radiographics 2024; 44:e230179. [PMID: 39024173 DOI: 10.1148/rg.230179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection that proliferates in the squamous epithelium and is the most common source of viral-related neoplasms. Low-risk subtypes (HPV-6 and -11) cause respiratory papillomas (laryngeal, tracheal, and bronchial) and condyloma acuminata of the penis, anus, and perineal region (anogenital warts). High-risk subtypes (HPV-16, -18, -31, and -33) are responsible for oropharyngeal squamous cell carcinoma (SCC) that involves the tongue base, tonsils, posterior pharyngeal wall, and larynx and malignancies of the anogenital region (cancers of the cervix, vagina, vulva, penis, and anal canal). Recent studies have increasingly shown a favorable treatment response and substantial differences in the overall prognosis associated with HPV-associated oropharyngeal cancers. Given this fact, oropharyngeal, cervical, and penile SCCs are classified as HPV-associated and HPV-independent cancers in the current World Health Organization classification. Imaging is essential in the early detection, diagnosis, and staging of HPV-associated cancers. Imaging also helps assess treatment response and postoperative complications and is used for long-term surveillance. HPV-associated oropharyngeal SCCs have well-defined borders and solid and cystic nodal metastases at imaging. Updated screening and vaccination guidelines are currently available that have great potential to decrease the overall disease burden and help control this worldwide public health concern. Novel therapeutic strategies, such as immunotherapies, are being explored, and imaging biomarkers that can predict treatment response and prognosis are being investigated; radiologists play a pivotal role in these efforts. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Venkata S Katabathina
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Sammar Ghannam
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Melissa Chen
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Brian Desalme
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Ryan Gabos
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Ifeadi Emejulu
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Preet K Sandhu
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Philip Valente
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Anil K Dasyam
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
| | - Srinivasa R Prasad
- From the Departments of Radiology (V.S.K., S.G., B.D., R.G., I.E.) and Pathology (P.V.), University of Texas Health San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (M.C., S.R.P.); Department of Radiology, Le Bonheur Children's Hospital, Memphis, Tenn (P.K.S.); and Department of Radiology, University of Pittsburg Medical Center, Pittsburg, Pa (A.K.D.)
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Bansal L, Arora S, Prasad A. Magnetic Resonance Imaging Evaluation of Wolffian Duct Anomalies - OHVIRA and OSVIRA. J Hum Reprod Sci 2024; 17:128-132. [PMID: 39091442 PMCID: PMC11290712 DOI: 10.4103/jhrs.jhrs_19_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 08/04/2024] Open
Abstract
Herlyn-Werner-Wunderlich syndrome in females, also known as obstructed haemivagina and ipsilateral renal agenesis (OHVIRA), and Zinner's syndrome, also known as OSVIRA in males, are two rare congenital syndromes affecting the urogenital tract. OHVIRA is obstructed haemivagina and ipsilateral renal agenesis and OSVIRA abbreviation stands for obstructed seminal vesicle and ipsilateral renal agenesis. For a long, these syndromes were considered different entities, owing to our poor understanding of underlying embryopathogenesis; however, in light of the recent acceptance of the Wolffian origin of the vagina in its entirety, these two syndromes are considered to be cut from the same cloth. In this case series, we present magnetic resonance imaging features of two cases each of OHVIRA and OSVIRA and discuss the similarities in embryopathogenesis behind them while debunking the old concepts. A deep understanding of embryopathogenesis allows a clinician and radiologist to predict the disease manifestation, and its outcome and also acts as a guide to screen for potential subtle defects, which would otherwise have been missed.
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Affiliation(s)
- Lukshay Bansal
- Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Suryansh Arora
- Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Akhila Prasad
- Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
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Moradi B, Hejazian SS, Tahamtan M, Ghorani H, Karami S. Imaging the post-treatment pelvis with gynecologic cancers. Abdom Radiol (NY) 2024; 49:1248-1263. [PMID: 38340181 DOI: 10.1007/s00261-023-04163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/05/2023] [Accepted: 12/14/2023] [Indexed: 02/12/2024]
Abstract
Gynecological malignancies, such as ovarian cancers, cervical cancers, and endometrial cancers, have a significant global impact. Women with gynecologic malignancies may receive a single or a combination of treatments, including surgery, chemotherapy, and radiation-based therapies. Radiologists utilize various diagnostic imaging modalities to provide the surgeon with relevant information about the diagnosis, prognosis, optimal surgical strategy, and prospective post-treatment imaging. Computerized Tomography (CT) and magnetic resonance imaging (MRI) may be used initially to evaluate and detect post-treatment complications. Although CT is primarily used for staging, MRI is commonly used for a more accurate evaluation of a tumor's size and detection of local invasion. Complications such as hematoma, abscess, inclusion cyst, seroma, tumor thrombosis, anorectovaginal fistula, and gossypiboma may occur after the three primary treatments, and systems such as the genitourinary, gastrointestinal, neurological, and musculoskeletal may be affected. In order to distinguish between early-onset and late-onset complications following gynecological treatment, radiological findings of the most common post-treatment complications will be presented in this review.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Women's Yas Hospital, Tehran, Iran
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Sina Hejazian
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Tahamtan
- Department of Radiology, Tehran University of Medical Sciences, Tehran, Iran
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Karami
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.
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Betova T, Trifonov R, Popovska S, Yordanov A, Karakadieva K, Dancheva Z, Kostov S. Primary Vaginal Mucinous Adenocarcinoma of Intestinal Type-Clinical, Radiological and Morphological Aspects. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:525. [PMID: 38674171 PMCID: PMC11052341 DOI: 10.3390/medicina60040525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Neoplasms of the vagina are rare and account for 1-2% of all tumors of the female reproductive system. Primary neoplasms of the vagina are most often carcinomas originating from squamous or glandular epithelium. Of the primary glandular tumors, clear cell, endometrioid, and serous adenocarcinomas are the most common types, while mucinous and mesonephric types are very rare. Mucinous adenocarcinoma is histologically subclassified into endocervical and intestinal types. We add to the existing literature another case of an extremely rare gynecological neoplasm-primary vaginal mucinous adenocarcinoma (PVMAC) intestinal type associated with vaginal villous adenoma with high-grade dysplasia. We discuss the clinical, radiological and morphological features of this rare entity. Materials and Methods: We report a case of a 59-year-old woman with PVMAC intestinal type associated with vaginal villous adenoma with high-grade dysplasia. The patient was evaluated with a gynecological exam, and biopsy, curettage and tumor excision were performed. The positron emission tomography-computed tomography (PET/CT) scan, at the level of the pelvis, supported the primary location of the disease. Histological and immunohistochemical methods were applied. Results: The gynecological examination of the vagina revealed an exophytic polypoid mass with a diameter of 3 cm, located on the posterior wall, in the area of introitus vaginae. The PET/CT scan revealed a hypermetabolic malignant formation involving the vagina and anal canal, without evidence of pelvic and inguinal lymphadenopathy, and also, it excluded disease at sites other than the vagina. The histological and immunohistochemical investigations, as well as the clinical and radiological data, lent support to the diagnosis "primary vaginal mucinous adenocarcinoma intestinal type". Conclusions: PVMAC intestinal type is a rare gynecological pathology, which presents a serious challenge for oncogynecologists, radiologists and pathologists.
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Affiliation(s)
- Tatyana Betova
- Department of Pathologoanatomy, Medical University—Pleven, 5800 Pleven, Bulgaria; (T.B.); (S.P.)
| | - Radoslav Trifonov
- Department of Radiology and Radiotherapy, Medical University—Pleven, 5800 Pleven, Bulgaria
| | - Savelina Popovska
- Department of Pathologoanatomy, Medical University—Pleven, 5800 Pleven, Bulgaria; (T.B.); (S.P.)
| | - Angel Yordanov
- Department of Gynecological Oncology, Medical University—Pleven, 5800 Pleven, Bulgaria; (A.Y.); (K.K.)
| | - Konstantina Karakadieva
- Department of Gynecological Oncology, Medical University—Pleven, 5800 Pleven, Bulgaria; (A.Y.); (K.K.)
| | - Zhivka Dancheva
- Department of Imaging Diagnostics, Interventional Radiology and Radiotherapy, Medical University—“Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria;
| | - Stoyan Kostov
- Department of Gynecology, Hospital “Saint Anna”, Medical University—“Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria;
- Research Institute, Medical University—Pleven, 5800 Pleven, Bulgaria
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Pulappadi VP, Manchanda S, Dhamija E, Jana M. Multimodality imaging of diseases of the vagina. Br J Radiol 2024; 97:513-525. [PMID: 38419147 DOI: 10.1093/bjr/tqad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/17/2023] [Accepted: 12/03/2023] [Indexed: 03/02/2024] Open
Abstract
Pathologies of the vagina are important causes of symptoms related to the genital tract in women. They can be missed on transabdominal ultrasonography (USG), which is the baseline modality used for evaluation of gynaecological complaints. Transperineal USG and MRI are the imaging modalities of choice for evaluation of the vagina. Diseases of the vagina can be grouped depending upon the age group in which they occur. In children and young adults, congenital anomalies like longitudinal or transverse vaginal septum, imperforate hymen, vaginal aplasia or atresia, and rectovaginal fistula can be seen. Malignant tumours can rarely occur in children, rhabdomyosarcoma being the most common one. Common diseases affecting adults include benign lesions like epidermoid, Gartner duct, and Bartholin cysts, and urogenital fistulas involving the vagina. Endometriosis and other benign tumours of vagina including leiomyoma, fibroepithelial polyp, and angiomyxoma are occasionally seen. Malignant tumours can be primary, the most common one being squamous cell carcinoma, or secondary, due to direct extension from cancers involving the adjacent organs. Characteristic morphological changes occur in the vagina after radiotherapy, which can be identified on imaging. Knowledge about the imaging appearances of these diseases is crucial in guiding appropriate management.
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Affiliation(s)
- Vishnu Prasad Pulappadi
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Smita Manchanda
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Ekta Dhamija
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Manisha Jana
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, India
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Ruaux E, Nougaret S, Gavrel M, Charlot M, Devouassoux-Shisheboran M, Golfier F, Thomassin-Naggara I, Rousset P. Endometriosis MR mimickers: T1-hyperintense lesions. Insights Imaging 2024; 15:19. [PMID: 38267748 PMCID: PMC10808095 DOI: 10.1186/s13244-023-01587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 01/26/2024] Open
Abstract
Endometriosis is a chronic and disabling gynecological disease that affects women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While MRI offers higher sensitivity compared to ultrasonography, it is prone to false-positive results, leading to decreased specificity. False-positive findings can arise from various T1-hyperintense conditions on fat-suppressed T1-weighted images, resembling endometriotic cystic lesions in different anatomical compartments. These conditions include hemorrhage, hyperproteic content, MRI artifacts, feces, or melanin. Such false positives can have significant implications for patient care, ranging from incorrect diagnoses to unnecessary medical or surgical interventions and subsequent follow-up. To address these challenges, this educational review aims to provide radiologists with comprehensive knowledge about MRI criteria, potential pitfalls, and differential diagnoses, ultimately reducing false-positive results related to T1-hyperintense abnormalities.Critical relevance statementMRI has a 10% false-positive rate, leading to misdiagnosis. T1-hyperintense lesions, observed in the three phenotypes of pelvic endometriosis, can also be seen in various other causes, mainly caused by hemorrhages, high protein concentrations, and artifacts.Key points• MRI in endometriosis has a 10% false-positive rate, leading to potential misdiagnosis.• Pelvic endometriosis lesions can exhibit T1-hyperintensity across their three phenotypes.• A definitive diagnosis of a T1-hyperintense endometriotic lesion is crucial for patient management.• Hemorrhages, high protein concentrations, lipids, and artifacts are the main sources of T1-hyperintense mimickers.
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Affiliation(s)
- Edouard Ruaux
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 165 Chemin du Grand Revoyet, EMR 3738, 69495, Pierre Bénite, France
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, U1194, Montpellier University, 34295, Montpellier, France
| | - Marie Gavrel
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mathilde Charlot
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 69495, Pierre Bénite, France
| | - François Golfier
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, 69495, Pierre Bénite, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Service Imageries Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 165 Chemin du Grand Revoyet, EMR 3738, 69495, Pierre Bénite, France.
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Chapagain S, Lama CS, Khadka B, Shrestha S, Karn M, Pandit C. An unusual case report of transverse vaginal septum presenting as primary amenorrhea. Int J Surg Case Rep 2024; 114:109132. [PMID: 38118240 PMCID: PMC10800634 DOI: 10.1016/j.ijscr.2023.109132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/22/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Outflow tract disorders are uncommon causes of primary amenorrhea. Transverse vaginal septum (TVS) is a rare cause of outflow tract obstruction. CASE PRESENTATION A 15-year-old female presented to us with severe abdominal pain. Abdominal examination revealed a boggy mass in the suprapubic region. The diagnosis was made following a history of primary amenorrhea, lower abdominal pain, and pelvic examination which revealed a vaginal septum. She had surgical resection of the vaginal septum and a mold was left in situ to keep the vagina patent during the healing process. The procedure was uneventful and she was able to achieve menstrual flow following surgery, septoplasty being performed after three months. DISCUSSION Transverse vaginal septum is an unusual cause of primary amenorrhea. These lesions, albeit rare, usually have a typical presentation and are amenable to surgical management. CONCLUSION Although transverse vaginal septum is a rare diagnosis in our practice, it is important to establish early diagnosis and carry out proper management so as to preserve normal physiology and fertility as well as to prevent complications.
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Affiliation(s)
- Sachita Chapagain
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal.
| | | | - Bijeeta Khadka
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
| | - Sabin Shrestha
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
| | - Mitesh Karn
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
| | - Chandika Pandit
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara 33700, Nepal
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McGettigan M, Zulfiqar M, Shetty AS. Imaging of Vaginal and Vulvar Malignancy. Radiol Clin North Am 2023; 61:651-670. [PMID: 37169430 DOI: 10.1016/j.rcl.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Vaginal and vulvar malignancies are rare gynecologic malignancies but can be associated with high morbidity and mortality if undiagnosed and untreated. Advanced imaging modalities such as MRI enable assessment of the local extent of disease and evaluation for regional or distant spread. Accurate identification and description of the primary lesion and sites of involvement as well as detection and localization of suspicious lymph nodes are critical in guiding appropriate management. Additionally, radiologists should be aware of potential mimickers on imaging and the differential diagnoses for vaginal and vulvar lesions.
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