Adenomyosis limited to a rudimentary uterine horn

Adenomyosis in a uterine horn of a patient with Mayer-Rokitansky-Kuster-Hauser syndrome

A 37-year-old woman with a previous diagnosis of Mayer-Rokitansky-Kuster-Hauser syndrome at 18 years of age was referred from a primary healthcare physician to a gynaecology appointment in our centre. She presented with a 2-year worsening pelvic pain and dyspareunia, symptoms that were previously absent and, at the time, with inadequate relief with oral analgesia. Physical examination showed absent uterine cervix and hypoplastic superior vagina. Transvaginal ultrasound and MRI suggested the presence of an hypoplasic uterus in left rotation. Laparoscopically, two asymmetric rudimentary horns were found, united by a fibrous central band, with an enlarged and congestive left horn. The three structures were removed as a whole. Histopathological examination reported the presence of multiple adenomyotic foci along the full thickness of the left rudimentary horn. The patient had an uneventful postoperative recovery and full remission of her symptoms.

Unilateral Obstructed Müllerian Anomalies: A Series of Unusual Variants of Known Anomalies

BACKGROUND

Obstructed Müllerian anomalies in adolescents can be grouped into complete outflow obstruction or unilateral outflow obstruction. The challenge with unilateral obstructions is that diagnosis can be delayed for weeks to years, as menstruation occurs normally through the patent side and thus obstruction is often not initially considered in the differential diagnosis.

CASES

In this case series, we present 3 unusual and challenging cases of unilateral Müllerian obstructions in adolescent female patients, along with strategies for diagnosis and management. Each case involves a unique variation of a recognized Müllerian anomaly that was initially misdiagnosed, leading to a significant delay in definitive diagnosis and treatment.

SUMMARY AND CONCLUSION

These cases highlight that even among the well-described Müllerian anomalies, there can be unusual variations. Patients who do not respond to initial management or who develop new symptoms should be further evaluated to confirm the correct diagnosis Tools that may be helpful in making the correct diagnosis include imaging studies that use contrast dye to better delineate cavities and their connections, magnetic resonance imaging with a radiologist experienced in Müllerian anomalies, and an examination under anesthesia. A definitive diagnosis is critical to the successful management of these conditions, and individualized management plans are required for each patient depending on their specific anomaly and their preferences for treatment.

Preoperative diagnosis of a rudimentary uterine horn

Two cases of rudimentary uterine horn were able to be diagnosed prior to operation. The case of rudimentary horn with cavity non-communicating to unicornuate uterus was easy to diagnose. Transabdominal ultrasonography and computed tomography (CT) demonstrated the uterus to have binodular structure and two uterine lumina. However, the case with pregnancy was difficult to diagnose. In this case, thick myometrium could be seen by ultrasonography to enclose the sac. In both cases hysterosalpingography revealed unicornuate uterus.