Bilateral cervical cancer in a complete septate uterus with a double cervix and vagina: a case report

Cervical cancer is one of the most common malignant tumours of female reproductive system. Concurrent chemoradiotherapy is the standard treatment for locally advanced cervical cancer and brachytherapy is an irreplaceable part of cervical cancer radiotherapy. However, bilateral cervical cancer in a complete septate is extremely rare. There is no standard consensus on the therapeutic management or follow-up owing to the rarity of this condition. This current case report presents an unusual case of a 25-year-old female patient with a double vagina and double uterus combined with a stage IIIC1r moderately differentiated squamous cell carcinoma in both cervices. This report introduces a treatment plan involving concurrent chemoradiotherapy for this rare and interesting case, focusing on a novel brachytherapy method, in which an intrauterine applicator, an applicator and an implantation needle were used. The tumours shrank significantly after chemotherapy and the novel brachytherapy.

Cervix Surgical uterine evacuation in patients with two cervices: a case series

OBJECTIVES

To describe the clinical circumstances, surgical approach, intraoperative challenges, and outcomes of patients with two cervices undergoing uterine evacuation for spontaneous, incomplete, or induced abortion at our institution.

STUDY DESIGN

We used diagnostic and procedure codes related to uterine anomalies and uterine evacuation to identify patients with cervical duplication who underwent uterine evacuation at Penn Medicine from January 2008 to December 2020.

RESULTS

We identified fifteen patients with cervical duplication in whom we performed uterine evacuations during nineteen pregnancies. We describe in detail each patient's first pregnancy with uterine evacuation at our institution, of which providers performed eleven in the first trimester and four in the second trimester. Ten patients had a known diagnosis of cervical duplication prior to pregnancy. Five patients did not have a diagnosis of cervical duplication prior to pregnancy and providers newly made this diagnosis intraoperatively either at our institution or referring clinics. Providers at outside institutions referred three patients to our institution for incomplete procedures. At our institution, one patient had a procedure notable for a major complication. Eight other cases were notable for surgical challenges including difficulty placing osmotic dilators, difficulty identifying the correct cervix for local anesthesia, and contralateral cervical and uterine horn instrumentation.

CONCLUSIONS

This case series suggests surgical abortion in patients with two cervices is rare, but generally safe. The majority of patients did not have major complications, despite presenting a variety of unique procedural challenges. Surgical providers were sometimes the first to make the diagnosis of a second cervix.

Delivery of double singleton pregnancies in a woman with a double uterus, double cervix, and complete septate vagina

Uterine anomalies involving a double uterus, double cervix, also known as didelphys uterus, and complete septate vagina are rarely seen and have an associated fertility problem. However, artificial reproductive technology with embryo transfers can help solve this fertility challenge. Conception in the uterus in just one side is commonly seen for embryos, which are always transferred through the usually used (dilated) vagina. We here present a patient with the above uterine anomaly who conceived with the aid of in vitro fertilization and embryo transfer to both uterine cavities under general anesthesia, which resulted in successful double singleton pregnancies with one fetus in each uterus. With intensive prenatal care, the pregnancy course for each fetus was rather uneventful. Although both fetuses were in cephalic presentation, cesarean section was performed at the 39(th) week of gestation with good outcomes in order to preclude anticipated difficulties if the baby had been delivered through the rarely dilated vagina. However, order of birth between the two fetuses was a crucial decision during the operation.

Double cervix: clarifying a diagnostic dilemma

OBJECTIVE

Although double cervix is often considered to indicate uterus didelphys, it may be challenging to determine the true associated anomaly as double cervix occurs with other müllerian anomalies. Our purpose is to report the frequency of uterine müllerian anomalies that occur with a double cervix and identify imaging or clinical criteria to help classify the associated anomaly.

STUDY DESIGN

After institutional review board approval, an electronic search was performed to identify patients with double cervix and pelvic magnetic resonance imaging (MRI) between 1976-2010 (using International Statistical Classification of Diseases and Related Health Problems, Edition 9 and Hospital International Classification of Diseases Adapted codes). MRIs were reviewed to classify the müllerian anomaly. Clinical characteristics including cervical canal thickness, intercervical distance and orientation were recorded. Kruskal-Wallis and χ(2) tests were used to test for differences in patient and imaging characteristics across müllerian anomalies.

RESULTS

There were 64 patients who met inclusion criteria: 32 (50%) septate uterus, 27 (42%) uterus didelphys and 5 (8%) bicornuate uterus. Cervical canal divergence was present in 34% (11/32) with septate uterus, 26% (7/27) with uterus didelphys, and none with bicornuate uterus. Mean intercervical distance was significantly greater (P < .001) in uterus didelphys (12.05 mm) compared with septate (5.43 mm) or bicornuate uterus (5.40 mm).

CONCLUSION

Septate uterus is as common as uterus didelphys, and considerably more common than bicornuate uterus, in women with a double cervix. Although a widened intercervical distance may support the MRI diagnosis of uterus didelphys, careful evaluation of the uterine fundus is required for correct diagnosis when encountering a double cervix.