The Rare, Unexpected Condition of a Twisted Leiomyoma in Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome: Etiopathogenesis, Diagnosis and Management. Our Experience and Narrative Review of the Literature

Laparoscopic intervention for solid pelvic tumours in Mayer-Rokitansky-Küster-Hauser syndrome: a case of bilateral uterine adenomyomas of the rudimentary uterus

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, a condition caused by Müllerian anomalies, is characterised by congenital vaginal aplasia and a rudimentary uterus. Case reports concerning uterine fibroids associated with MRKH syndrome are limited, and differentiating between uterine fibroids and ovarian solid tumours prior to surgical intervention is often challenging. Here, we present the case of a patient with MRKH syndrome and asymptomatic bilateral pelvic solid tumours located close to both ovaries. Based on intraoperative and histopathological findings, the tumours were diagnosed as adenomyomas of the rudimentary uterus. This is the first reported case of a uterine adenomyoma associated with MRKH syndrome. Moreover, our report highlights the fact that diagnostic laparoscopy is a valuable method to evaluate pelvic tumours in MRKH syndrome.

Women's Health and Gynecology: Old Challenges and New Insights

The complexity of women's health goes far beyond medical and surgical knowledge and the achievements of the clinical specialty of Obstetrics and Gynecology, spanning not just the research dimensions of molecular biology, genetics, epidemiology, or health services but also being influenced by gender, social, and psychological relevant factors [...].

Genome Sequencing and Transcriptome Profiling in Twins Discordant for Mayer-Rokitansky-Küster-Hauser Syndrome

To identify potential genetic causes for Mayer-Rokitansky-Küster-Hauser syndrome (MRKH), we analyzed blood and rudimentary uterine tissue of 5 MRKH discordant monozygotic twin pairs. Assuming that a variant solely identified in the affected twin or affected tissue could cause the phenotype, we identified a mosaic variant in ACTR3B with high allele frequency in the affected tissue, low allele frequency in the blood of the affected twin, and almost absent in blood of the unaffected twin. Focusing on MRKH candidate genes, we detected a pathogenic variant in GREB1L in one twin pair and their unaffected mother showing a reduced phenotypic penetrance. Furthermore, two variants of unknown clinical significance in PAX8 and WNT9B were identified. In addition, we conducted transcriptome analysis of affected tissue and observed perturbations largely similar to those in sporadic cases. These shared transcriptional changes were enriched for terms associated with estrogen and its receptors pointing at a role of estrogen in MRKH pathology. Our genome sequencing approach of blood and uterine tissue of discordant twins is the most extensive study performed on twins discordant for MRKH so far. As no clear pathogenic differences were detected, research to evaluate other regulatory layers are required to better understand the complex etiology of MRKH.

Urinary retention unveiling deeply embedded multiple leiomyomas in women with Mayer–Rokitansky–Kuster–Hauser syndrome and its successful laparoscopic management: a case-report and literature review

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome is the second most common cause of primary amenorrhea with an incidence of 1:4000–5000 women. It is characterized by aplasia or hypoplasia of the uterus and the upper two-thirds of the vagina with normal ovaries and tubes and a normal secondary sexual characteristics. The occurrence of leiomyoma is common but it is rare to have leiomyoma in uterine remnant in MRKH syndrome. Although few cases of MRKH syndrome with leiomyoma have been reported in the literature, none presented with urinary retention. Here, we report a case of 28-year-old women who presented with urinary retention that unmasked deeply embedded huge fibroids in pelvis arising from a rudimentary uterine horns and its safe management via laparoscopic approach.

Mayer-rokitansky-kuster-hauser syndrome with presacral schwannoma presenting as a pelvic mass: A literature review and case report

A 32-year-old woman was admitted to our gynecology outpatient clinic with primary amenorrhea, a pelvic mass, and pain. Sonographic examination and magnetic resonance imaging revealed an approximately 124×103 mm heterogeneous mass. Moreover, laparotomy revealed fibrotic uterine bands with normal ovaries, tubes, and a solid retroperitoneal lesion. On the second postoperative day, the mass was removed, and the patient was discharged with full recovery. Microscopic examination of the pelvic mass confirmed the diagnosis of schwannoma. To the best of our knowledge, this is the first report on the co-occurrence of Mayer-Rokitansky-Küster-Hauser syndrome and schwannoma, without the presence of any other pathology.