Mullerian Anomalies Research Articles

Double cervix and vagina with a normal uterus: an unusual Mullerian anomaly

A 34 year old woman presented with primary infertility and duplication of the cervix and vagina. Laparoscopy demonstrated a normal uterus and hysterosalpingography revealed a normal uterine cavity communicating with both cervices. This rare Mullerian anomaly is inconsistent with our current understanding of Mullerian development. An alternative embryological mechanism is reviewed to account for this and other anomalies which do not fit into existing classification systems.

Laparoscopic Management of a Unicornuate Uterus with a Rudimentary Horn

ABSTRACT Surgical intervention in cases of mullerian anomalies is controversial. The general consensus in cases of rudimentary horns with a functional endometrium is to remove them. We present a case of laparoscopic removal of a rudimentary horn. Lateral control of vessels is quite easy to perform using an endoscopic stapler. Separation of the rudimentary horn from the uterus was accomplished with unipolar cautery and scissors. This report confirms the role of laparoscopy in the management of a unicornuate uterus with a rudimentary horn. (J GYNECOL SURG 11:105, 1995)

MR Imaging in the Evaluation of Mullerian Duct Anomalies

MR Imaging in the Evaluation of Mullerian Duct Anomalies

Hematometra as a Cause of Lumbar Radiculopathy

Low-back pain combined with a positive straight leg raising test (Lasègue's sign) is uncommon in children and adolescents. Reproductive tract (Mullerian) anomalies causing an accumulation of menstrual blood in the vagina, uterus, and fallopian tubes represent an unusual extraspinal cause of low-back pain. The accumulation of blood in these cavities is termed hematocolpos, hematometra, and hematosalpinx. Amenorrhea with cyclic lower abdominal pain and a presenting pelvic mass are the usual presenting features. In the current report, we describe a case of an adolescent with low-back pain, positive straight leg raising test, and signs of L5 radiculopathy that were attributable to hematometra secondary to congenital partial absence of a vagina. This appears to be the first report of this type of presentation.

Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography.

The purpose of this study was to compare the relative accuracy of magnetic resonance (MR) imaging (n = 26), endovaginal sonography (EVS) (n = 14), and hysterosalpingography (HSG) (n = 20) in the classification of mullerian duct anomalies in 26 patients. There were 24 cases of surgically proved anomaly, and two patients had normal uteri (one with a vaginal septum). MR imaging allowed diagnosis of 24 of 24 cases (accuracy, 100%), and EVS was correct in 11 of 12 cases (accuracy, 92%). HSG was correct in only four cases. In the diagnosis of septate uterus, MR imaging demonstrated a sensitivity and specificity of 100% and EVS demonstrated a sensitivity of 100% and a specificity of 80%. Both MR imaging and EVS demonstrated a sensitivity and specificity of 100% in distinguishing those anomalies that did not require surgery. The high accuracy of MR imaging and EVS permit noninvasive differentiation of uterine anomalies and can spare women diagnostic laparoscopy, promoting cost-effective diagnosis.

Mullerian Anomaly Associated with the Basal Cell Nevus Syndrome

ABSTRACT The basal cell nevus syndrome (BCNS) is a multisystem disorder associated with ovarian fibromas and fibrosarcomas. We report the first case of the association of this syndrome with mullerian anomalies that were confirmed radiologically and at exploratory surgery. (J GYNECOL SURG 8:183, 1992)

Müllerian Anomalies and Renal Agenesis: Autosomal Dominant Urogenital Adysplasia

We report two families in which mullerian anomalies or renal agenesis appeared to be caused by an autosomal dominant gene that produces unilateral or bilateral renal agenesis and a spectrum of mullerian anomalies. This single gene disorder may account for the high incidence of mullerian anomalies observed in females with bilateral renal agenesis and the increased frequency of renal anomalies in patients with mullerian malformations. The range of mullerian anomalies in this disorder includes bicornuate uterus, uterus didelphys, Rokitansky- Kuster -Hauser syndrome (vaginal atresia with or without absence of the uterus), and total mullerian aplasia. Gene expression is not sex limited. Affected males can have bilateral or unilateral renal agenesis, and possibly may have unilateral or bilateral absence of the vas deferens or seminal vesicles. We suggest that autosomal dominant urogenital adysplasia is common, but underdiagnosed because of the deceptive variability in gene expression. In addition, reduced gene penetrance and reduced biologic fitness from lethal renal anomalies or genital tract anomalies may obscure the autosomal dominant nature of this disorder in most families.

Menstrual Problems

A reader asked why Litt did not recommend the use of pelvic ultrasound as an aid in the diagnosis of amenorrhea (PIR 4:203, January 1983). Dr Litt responds: Pelvic ultrasound can certainly be helpful in ascertaining the presence or absence of ovaries and Mullerian duct structures and, thus, might have a place in the evaluation of a patient with primary amenorrhea. Similarly, it is often (but not always) possible to demonstrate polycystic ovaries by this method. We have not relied on it, however, because gonadotrophin analysis provides accurate information about the first (ovarian agenesis) and the last (polycystic ovaries) and Mullerian duct anomalies can best be explored by laparoscopy.

Etiologies and Subsequent Reproductive Performance of 100 Couples with Recurrent Abortion

From 1968 through 1977, 100 couples with documented recurrent reproductive failure were evaluated in the reproductive endocrine unit of the Medical College of Georgia. All couples underwent cytogenetic studies, radiologic evaluation of the Mullerian system, and timed endometrial biopsy. Recurrent pregnancy wastage was found to be associated with genetic disorders in 25 couples, Mullerian anomalies in 15, endocrine anomalies in 23, and negative findings in 37. The subsequent reproductive performance of each group is reviewed.

Understanding Electrocardiography; Physiological and Interpretive Concepts

Part 1 Reproductive Physiology: Genetics/Molecular Genetics Embryology & Sexual Differentiation Hypothalamus & Reproductive Disorders Puberty Ovarian Follicular Growth & Maturation Pharmacology of Reproductive Hormones. Part 2 Dislocated Intraocular Lenses: Primary Amenorrhea Dysfunctional Uterine Bleeding Hyperprolactinemia Hyperandrogenism Polycystic Ovary Syndrome Thyroid Disease Adrenal Disease. Part 3 Contraception: Overview Metabolic Effects of Oral Contraceptives Oral Contraceptive Use & Neoplasia The Future. Part 4 Infertility Evaluation: Evaluation of the Infertile Couple Cervical Factors in Infertility Male Factor Infertility Immunologic Infertility Sperm Antibodies Diagnosis of Ovulatory Defects Luteal Phase Defects Unexplained lnfertility Emotional Aspects of Infertility Hysterosalpingography Endoscopy/Laparoscopy Semen Evaluation. Part 5 Therapy of Infertility: Induction of Ovulation Monitoring of Ovulation Induction of Ovulation with Clomiphene Induction of Ovulation with Gonadotropins Induction of Ovulation with GnRH Ovulation Hyperstimulation Adhesions Medical Treatment of Endometriosis Surgical Treatment of Endometriosis Leiomyomata Surgery of the Male Reproductive Tract. Part 6 Assisted Reproductive Technologies AIH/IUI AID Cryopreservation of Sperm Gamete Intrafallopian Transfer Oocyte Assessment In Vitro Fertilization Cryopreservation of Eggs/Embryos Donor Eggs. Part 7 Problems with Pregnancy: Reproductive Pregnancy Wastage Endocrinology of Early Pregnancy Ectopic Pregnancy Lactation and Its Disorders. Part 8 Menopause: Menopause Overview Premature Ovarian Failure Menopause and Osteoporosis Menopause and Atherosclerosis. Part 9 Specialized Procedures: Ultrasound Hysteroscopy and Endometrial Ablation Laser Surgery Microsurgical Tubal Reconstruction & Reversal of Sterilization Mullerian Duct Anomalies Radioimmunoassays.