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Udayakumar N, Smith E, Boone A, Porter KK. A Common Path: Magnetic Resonance Imaging of Müllerian and Wolffian Duct Anomalies. Curr Urol Rep 2023; 24:1-9. [PMID: 36595101 DOI: 10.1007/s11934-022-01138-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the pathway of Mullerian and Wolffian duct development, anomalies that result from disruptions to this pathway, and the characteristics on advanced imaging that identify them. RECENT FINDINGS In-office evaluation for reproductive anomalies is usually inadequate for the diagnosis of congenital reproductive anomalies. Magnetic resonance imaging (MRI) has usurped invasive diagnostic methods including laparoscopy, hysteroscopy, and vasography as the new gold standard. Because of its superior soft-tissue delineation and the availability of advanced functional sequences, MRI offers a sophisticated method of distinguishing reproductive anomalies from one another, characterizing the degree of defect severity, and evaluating for concomitant urogenital anomalies non-invasively and without radiation exposure to the patient. Congenital anomalies of the Mullerian and Wolffian duct can be incredibly nuanced, requiring prompt and accurate diagnosis for management of infertility. Definitive diagnosis should be made early with MRI.
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Affiliation(s)
- Neha Udayakumar
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - Elainea Smith
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy Boone
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Zhang H, Zheng Y, Ning G, Fu C, Bao L. Preoperative MRI presentations of Herlyn-Werner-Wunderlich syndrome. Congenit Anom (Kyoto) 2022; 62:228-235. [PMID: 35941518 DOI: 10.1111/cga.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/22/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
Herlyn-Werner-Wunderlich (HWW) syndrome is a rare complex female urogenital anomaly, with diverse anatomical presentations. Due to obstruction, most patients with HWW syndrome need to be addressed surgically. The treatment strategy should be tailored to the different anatomical variants of each patient. Therefore, a detailed and comprehensive preoperative evaluation is needed. In this review, we describe the embryology and clinical manifestations of HWW syndrome and discuss and illustrate its diverse preoperative magnetic resonance imaging presentations to guide clinical treatment.
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Affiliation(s)
- Heng Zhang
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Zheng
- Department of Gynecology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gang Ning
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chuan Fu
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Bao
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Golawski KM, Lipa M, Brawura-Biskupski-Samaha R, Szymusik I, Wielgos M. One patient with two uteri and two pregnancies - a rare case of twins in a patient with uterus didelphys. Ginekol Pol 2022; 92:905-906. [PMID: 35014017 DOI: 10.5603/gp.a2021.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
We report an extraordinary case of double pregnancy in patient with uterus didelphys. This anatomic anomaly originates from the lack of fusion of the paired Mullerian ducts during embryological development with 0.3% prevalence in the population. The patient presented to our department with initial diagnosis which was confirmed during ultrasound examination at 12 weeks - uterus didelphys with dichorionic diamniotic twin gestation. Further ultrasound scans were performed every 4 weeks and revealed small for gestational age fetuses. Due to the uterine malformation and the history of cesarean section, the patient was qualified for an elective cesarean section at 36 weeks of gestation - two premature neonates were delivered in good general conditions.
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Affiliation(s)
- Ksawery M Golawski
- Student's Scientific Association at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Michal Lipa
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
| | | | - Iwona Szymusik
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
| | - Miroslaw Wielgos
- 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland
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Grover SB, Antil N, Katyan A, Rajani H, Grover H, Mittal P, Prasad S. Niche role of MRI in the evaluation of female infertility. Indian J Radiol Imaging 2020; 30:32-45. [PMID: 32476748 PMCID: PMC7240899 DOI: 10.4103/ijri.ijri_377_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/16/2020] [Accepted: 02/11/2020] [Indexed: 02/05/2023] Open
Abstract
Infertility is a major social and clinical problem affecting 13-15% of couples worldwide. The pelvic causes of female infertility are categorized as ovarian disorders, tubal, peritubal disorders, and uterine disorders. Appropriate selection of an imaging modality is essential to accurately diagnose the aetiology of infertlity, since the imaging diagnosis directs the appropriate treatment to be instituted. Imaging evaluation begins with hystero- salpingography (HSG), to evaluate fallopian tube patency. Uterine filling defects and contour abnormalities may be discovered at HSG but usually require further characterization with pelvic ultrasound (US), sono-hysterography (syn: hystero-sonography/saline infusion sonography) or pelvic magnetic resonance imaging (MRI), when US remains inconclusive. The major limitation of hysterographic US, is its inability to visualize extraluminal pathologies, which are better evaluated by pelvic US and MRI. Although pelvic US is a valuable modality in diagnosing entities comprising the garden variety, however, extensive pelvic inflammatory disease, complex tubo-ovarian pathologies, deep-seated endometriosis deposits with its related complications, Mulllerian duct anomalies, uterine synechiae and adenomyosis, often remain unresolved by both transabdominal and transvaginal US. Thus, MRI comes to the rescue and has a niche role in resolving complex adnexal masses, endometriosis, and Mullerian duct anomalies with greater ease. This is a review, based on the authors' experience at tertiary care teaching hospitals and aims to provide an imaging approach towards the abnormalities which are not definitively diagnosed by ultrasound alone.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Neha Antil
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Amit Katyan
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Heena Rajani
- Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Hemal Grover
- Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA
| | - Pratima Mittal
- Department of Obstetrics and Gynecology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sudha Prasad
- Department of Obstetrics and Gynecology, Maulana Azad Medical College, New Delhi, India
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Post RJ, Templeman CL, Benoit RM. Twin gestation in a uterus didelphys with only one functional cervix: A case report. Case Rep Womens Health 2019; 22:e00118. [PMID: 31080753 DOI: 10.1016/j.crwh.2019.e00118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/21/2019] [Accepted: 04/25/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction Twin gestation in a uterus didelphys with one fetus in each uterine cavity is rare and presents unique challenges in antepartum and intrapartum care. Case Presentation A 35-year-old woman with a uterus didelphys became pregnant with twins, with one fetus in each uterus, after intrauterine insemination of a single visible cervix. Multiplanar ultrasonography showed the presence of one complete cervix and a second hypoplastic cervix; it was unclear whether she could deliver both twins vaginally. Her pregnancy was complicated by fetal growth restriction of twin B. At 38 weeks, the patient underwent scheduled cesarean section and delivered two viable twins. Conclusion Determining the precise anatomy of Mullerian duct anomalies, including the cervix and vagina, is important for obstetrical management. Twin pregnancy in a uterus didelphys is very rare and presents unique obstetric challenges. The presence of a Mullerian duct anomaly is not necessarily an indication for cesarean section, but it may increase the risk. Not all Mullerian duct anomalies fall under the 1988 American Society for Reproductive Medicine (ASRM) classification system. Adequate imaging to determine the anatomy of a Mullerian duct anomaly is crucial for counseling pregnant patients. Three-dimensional multiplanar ultrasound imaging may be of special use.
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Wang Y, Lu J, Zhu L, Chen R, Jiang B, Hou B, Feng F, Jin Z. Increased incidence of abnormally located ovary in patients with Mayer-Rokitansky-Küster-Hauser syndrome: a retrospective analysis with magnetic resonance imaging. Abdom Radiol (NY) 2018; 43:3142-3146. [PMID: 29582123 DOI: 10.1007/s00261-018-1575-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To explore the incidence of abnormally located ovary in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome as compared to a control group with magnetic resonance imaging. METHODS Pelvic MR images of 83 MRKH patients and 60 age-matched normal females were retrospectively reviewed by two experienced gynecological radiologists in consensus. Characteristics including location of ovary, ovarian volume, and follicle counts were assessed. The incidence of abnormally located ovary was compared between MRKH patients and controls. The ovarian size and follicle counts were compared among three groups: abnormally located ovaries in MRKH patients, eutopic ovaries in MRKH patients, and normal controls. RESULTS In total, 166 ovaries of 83 MRKH patients and 120 ovaries of 60 control females were evaluated. Thirty-seven ovaries of 23 MRKH patients (28%, 23/83) were abnormally located, whereas 3 ovaries of three control females (5%, 3/60) were located in abnormal positions (P < 0.001). The mean volume was 9.2 ± 6.3 mL of the abnormally located ovaries in MRKH patients, 7.8 ± 4.0 mL of the eutopic ovaries in MRKH patients, and 8.9 ± 4.8 mL in control females (P > 0.05). No obvious differences were observed with regard to follicle counts among the three groups. CONCLUSION Incidence of abnormally located ovary was significantly increased in patients with MRKH syndrome. Such knowledge is important for infertility treatment, evaluation of pelvic pain, and surgical planning for MRKH patients.
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Affiliation(s)
- Yue Wang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China
| | - Jingjing Lu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China.
| | - Rong Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China
| | - Bo Jiang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China
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Zhang A, Zeng X, Woo JJ, Morrell M, Xu D. An unusual case of Herlyn-Werner-Wunderlich syndrome with a complete septate uterus and complicated urinary tract with rare ectopic ureteral opening. Int J Gynaecol Obstet 2018; 143:248-250. [PMID: 29959772 DOI: 10.1002/ijgo.12578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/17/2018] [Accepted: 06/28/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Aiqian Zhang
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha City, Hunan Province, China
| | - Xiangyang Zeng
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha City, Hunan Province, China
| | - Jeffrey JeChuen Woo
- Department of Obstetrics and Gynecology, Riverside Regional Medical Center, Newport News, VA, USA
| | - Miriam Morrell
- Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha City, Hunan Province, China
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Wang Y, Lu J, Zhu L, Sun Z, Jiang B, Feng F, Jin Z. Evaluation of Mayer-Rokitansky-Küster-Hauser syndrome with magnetic resonance imaging: Three patterns of uterine remnants and related anatomical features and clinical settings. Eur Radiol 2017; 27:5215-5224. [PMID: 28674963 DOI: 10.1007/s00330-017-4919-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/17/2017] [Accepted: 05/31/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To characterize the anatomical features and clinical settings of Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and correlate them with patterns of uterine involvement. METHODS Pelvic magnetic resonance images and medical records of 92 MRKH patients were retrospectively reviewed. Patients were subgrouped by uterine morphology: uterine agenesis, unilateral rudimentary uterus and bilateral rudimentary uteri. Uterine volume, presence of endometrium, location of ovary, endometriosis and pelvic pain were compared among groups. RESULTS The mean uterine volume was 33.5 ml (17.5-90.0 ml) for unilateral uterine remnants, and 16.1 ml (3.5-21.5 ml) for bilateral uterine rudiments (p<0.01). The incidence of presence of endometrium (100% vs. 22%, p<0.001), haematometra (56% vs. 3%, p<0.001) and ovarian endometriosis (22% vs. 3%, p<0.01) was significantly increased in the group of unilateral rudimentary uteri as compared with the group of bilateral uterine remnants. Thirty-one patients (38%) showed ectopic ovaries. Pelvic pain was more common in individuals with unilateral rudimentary uterus than those who had no (56% vs. 5%, p<0.01) or bilateral uterine remnants (56% vs. 14%, p<0.05). CONCLUSION MRKH patients with different patterns of uterine involvement may have differentiated anatomical features and clinical settings. KEY POINTS • Rudimentary uteri, especially bilateral rudimentary uteri, were quite common in MRKH syndrome. • Uterine remnants can be relatively large, especially the unilateral rudimentary uterus. • Presence of endometrium and related complications are not rare in MRKH syndrome. • Existence of endometrium and complications are more frequent in unilateral rudimentary uterus.
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Affiliation(s)
- Yue Wang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Jingjing Lu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Lan Zhu
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China.
| | - Zhijing Sun
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Bejing, 100730, People's Republic of China
| | - Bo Jiang
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Dongcheng District, Beijing, 100730, People's Republic of China
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Xu Z, Wu S, Xing Q, Wang X, Xiang H, Xu Y, Wang J, He X, Wang B, Cao Y. Genetic association between PAX2 and mullerian duct anomalies in Han Chinese females. J Assist Reprod Genet 2016; 34:125-129. [PMID: 27722936 DOI: 10.1007/s10815-016-0807-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 08/30/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The study aims to investigate the genetic association between paired box gene 2 (PAX2) and mullerian duct anomalies (MDA) in Chinese Han females. METHODS Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was used to identify the genotypes of three tag single nucleotide polymorphisms (SNPs) in PAX2 in 362 MDA cases and 406 controls. RESULTS We found that one tag SNP (rs12266644) of PAX2 was associated with susceptibility to MDA. The genotype distributions of the SNP rs12266644 have a statistically significant difference in the MDA patients and controls with a p value = 0.008. In the dominant model, we also observed that the GT + TT genotype increased the risk for MDA (p = 0.015, OR = 1.637, 95 % CI = 1.096-2.443). CONCLUSION The polymorphism rs12266644 of PAX2 might be a risk factor for MDA in Chinese Han females.
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Affiliation(s)
- Zuying Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Shinan Wu
- Graduate School of Peking Union Medical College, Beijing, China.,Center for Genetics, National Research Institute for Family Planning, 12 Dahuisi Road, Haidian, Beijing, 100081, China
| | - Qiong Xing
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Xi Wang
- Center for Genetics, National Research Institute for Family Planning, 12 Dahuisi Road, Haidian, Beijing, 100081, China
| | - Huifen Xiang
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Yuping Xu
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Jing Wang
- Department of Medical Genetics, The Capital Medical University, Beijing, China
| | - Xiaojin He
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China.,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China
| | - Binbin Wang
- Graduate School of Peking Union Medical College, Beijing, China. .,Center for Genetics, National Research Institute for Family Planning, 12 Dahuisi Road, Haidian, Beijing, 100081, China.
| | - Yunxia Cao
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, China. .,Institute of Reproductive Genetics, Anhui Medical University, Hefei, China. .,Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China.
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Liu Q, Zhang Q, Wu YZ, Zhou QM, Guan Q, Yang LD, Shi QL. Nearly Normal Congenital Cervical Fragmentation: A Hard-To-Diagnose and Successful End-To-End Anastomosis. J Pediatr Adolesc Gynecol 2015; 28:e87-90. [PMID: 25817766 DOI: 10.1016/j.jpag.2014.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 08/03/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Congenital cervical fragmentation is a very rare genital tract malformation that usually presents in adolescence with primary amenorrhea and cyclic, monthly, lower abdominal pain. We report a nearly normal case of congenital cervical fragmentation and successful end-to-end anastomosis. CASE A 15-year-old girl presented with primary amenorrhea with cyclic, monthly lower abdominal pain lasting for 15 months without any abnormal imaging findings (pelvic CT scan, ultrasonography, and hysteroscopy). Misdiagnosis and appendectomy was performed at the time of the initial lower abdominal pain. Diagnostic combined hysteroscopy and laparoscopy were performed in our hospital, and cervical fragmentation was diagnosed. A converted laparotomy end-to-end anastomosis was performed successfully, and regular menstruation was restored after the operation. SUMMARY AND CONCLUSION The malformation of nearly normal congenital cervical fragmentation is existent and hard to diagnose. As long as the patient has persistent primary amenorrhea with cyclic, monthly lower abdominal pain, even if no abnormal findings on imaging, obstructive malformation of the reproductive duct should be the primary suspicion. Diagnosis and treatment should occur as early as possible to preserve the patient's fertility. End-to-end anastomosis is the best method for this type of patient.
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Affiliation(s)
- Qi Liu
- Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China
| | - Qin Zhang
- Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China
| | - Yuan-Zhe Wu
- Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China
| | - Qiu-Ming Zhou
- Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China
| | - Qun Guan
- Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China
| | - Lin-Dong Yang
- Department of Gynecology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China
| | - Qun-Li Shi
- Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Jiangsu Province, China.
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Abstract
Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome, is a rare syndrome with only a few hundred reported cases described since 1922. Only a handful of these cases have been associated with pyocolpos. Mullerian duct anomalies have an incidence of 2-3%. While OHVIRA constitutes 0.16-10% of these Mullerian duct anomalies. Symptoms usually present shortly after menarche when hematocolpos develops during menstruation resulting in dysmenorrhea and a pelvic mass. The pelvic mass is the collection of blood products within the obstructed hemivagina. The first study in the diagnostic work-up is usually ultrasonography, which typically demonstrates a pelvic fluid collection which can simulate other disease processes thus confounding the diagnosis. MRI findings of the pelvis reveal a didelphic uterus. Imaging of the abdomen reveals agenesis of the ipsilateral kidney. MRI is beneficial in characterizing the didelphic uterus and vaginal septum for pre-operative planning. Understanding the imaging findings, in conjunction with the clinical presentation, is critical for early diagnosis in attempting to prevent complications such as endometriosis or adhesions from chronic infections with subsequent infertility.
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Affiliation(s)
- Deven Cox
- Department of Radiology, Tripler Army Medical Center, Honolulu, HI 96859, USA.
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