First Trimester Uterine Rupture: A Case Report on a Patient with Unsuspected Müllerian Duct Anomaly

Introduction: Mullerian malformations are a group of malformations that result from an alteration of embryonic development. Most cases are asymptomatic, however, in pregnant patients it has been associated with recurrent abortion or premature delivery. Case presentation: 12 + 2 weeks pregnant woman consulted for abdominal pain, vomiting and fever. During the study, a transvaginal ultrasound was performed, where two endometric cavities and a pregnancy in the right horn were observed. The evolution of the patient was torpid, reaching hypovolemic shock, resolved by an emergency laparotomy where the rupture of the right horn was found. Discussion: The bicornuate uterus is the consequence of a partial fusion of the paramesonephric ducts during the fetal development, resulting in two functional uterine horns. Patients with bicornuate uterus may be asymptomatic, a uterine rupture is a rare but potentially severe complication of the bicornuate uterus and is usually presented during first and second trimester. Conclusions: Pregnancy with Mullerian anomalies often has preterm delivery, IUGR and malpresentation, and even more severe complication as uterine ruptura, so, requires proper counselling and close monitoring during antenatal period.

Vaginal clear cell adenocarcinoma in Herlyn-Werner-Wunderlich syndrome:A case report

BACKGROUND Herlyn-Werner-Wunderlich(HWW)syndrome is a rare Müllerian duct anomaly,characterized by a combination of urogenital abnormalities.The occurrence of primary cervico-vaginal carcinomas in patients with HWW syndrome is excep-tionally rare,posing significant challenges for screening,early diagnosis,and effective management.CASE SUMMARY We report a rare case of primary clear cell carcinoma of the vagina complicated in a 40-year-old woman with HWW syndrome.The patient presented with irregular vaginal bleeding for 4 years.On gynecological examination,an oblique vaginal septum was suspected.Surgical resection of the vaginal septum revealed a com-municating fistula and a tumor on the left vagina and the left side of the septum,which was confirmed as clear cell carcinoma.One month later,she underwent a radical hysterectomy,vaginectomy,bilateral salpingo-oophorectomy,and pelvic lymph node dissection.Due to significant side effects,she completed only one course of chemotherapy.A year later,lung metastasis was detected and continued to grow.A thoracoscopic wedge resection of the right upper lobe was performed 4 years after the initial surgery.We also conducted a systemic review of the lite-rature on primary cervical or vaginal carcinoma in HWW syndrome to explore this rare entity.CONCLUSION Cervico-vaginal adenocarcinomas in patients with HWW syndrome are occult,and require early surgical intervention and regular imaging surveillance.

Diagnosis and laparoscopic excision of accessory cavitated uterine mass in a young woman:A case report

BACKGROUND Accessory and cavitated uterine mass(ACUM)is an uncommon form of connate Müllerian anomaly seen in young and nulliparous women,which presents as chronic periodic pelvic pain and severe dysmenorrhea.The entity is often underdiagnosed due to a broad differential diagnosis,including rudimentary uterine horn,true cavitated adenomyosis and degenerating fibroids.CASE SUMMARY A 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with cystic adenomyosis.Gynecological examination and ultrasonography were performed.The patient underwent laparoscopic excision of the mass and histopathological examination confirmed the diagnosis.Postoperatively,the patient did well,with no further dysmenorrhea.CONCLUSION ACUM is difficult to diagnose.A correct diagnosis can be made only after excision and histopathological evaluation.Surgical excision is necessary and can be carried out by laparoscopy.

Unilateral Singleton Pregnancy with Rural Vaginal Delivery in a Woman with Uterus Didelphys

Background: Uterus didelphys is a Müllerian duct anomaly which is clinically significant because only 45% of UD patients achieve term delivery and have associated increased risk of spontaneous abortion, foetal growth retardation, mal presentation, and a significant caesarean section delivery rate. Case: A 26-year-old Gravida 2 Para 1 Abortion 1 woman with uterus didelphys and associated complete, non-communicating, longitudinal vaginal septum carries a pregnancy to term in her right uterus in rural Canada. She delivers her baby at 41 weeks gestational age via vacuum assisted spontaneous vaginal delivery. Conclusion: This case report supports more recent literature that uterus didelphys should not be considered as an absolute indication for caesarean delivery. A trial of labour is conceivable with obstetrician gynaecologist involvement in more rural centers with a care plan in place.

A giant Müllerian duct cyst in the perineum:a case report

The authors present a case report of a giant Müllerian duct cyst in the perineum.A 37-year-old man presented with a mass with the size of 50 cm×40 cm×30 cm in the perineum.Computed tomography(CT)scan and magnetic resonance imaging(MRI)of the pelvis and perineum found a huge multilocular cystic mass.X-ray film of the pelvis showed a giant soft-tissue shadow of high density in the perineum.Voiding cystourethrogram did not show any cyst interlinked to posterior urethra.After related examinations,the patient underwent open surgical resection of the cyst.Pathologic examination confirmed the presence of a Müllerian duct cyst.Huge Müllerian duct cyst is uncommon in clinic.Treatments of Müllerian duct cysts depend on their sizes and symptoms.

苗勒管细胞的分离及苗勒管抑制素受体定位的免疫电镜观察

本实验应用胰酶消化后的Percoll梯度分离技术,将苗勒管上皮细胞与间质细胞分离开来,然后分别进行细胞培养。一部分与同胚龄睾丸或卵巢联合培养,观察生殖腺分泌的苗勒管抑制素(MIS)对两类细胞致死率的差异;另一部分以MIS抗体为第一抗体,HRP-羊抗兔IgG或抗生物素-胶体金为第二抗体,作免疫电镜技术,显示苗勒管上皮细胞和间质细胞上MIS受体的结合位点。实验结果表明,睾丸分泌的MIS使培养的苗勒管上皮细胞致死率与对照组相比,有非常显著差异(P<0.001),对间质细胞致死率不明显,但MIS受体结合位点的免疫反应不仅出现在苗勒管上皮细胞上,也显示在间质细胞上。本文讨论了MIS的作用机理。