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Ibidapo-Obe O, Okudo J, Filani O. Incidental Finding of Leiomyoma in Mayer-Rokitansky-Kuster-Hauser Syndrome. J Investig Med High Impact Case Rep 2021; 9:23247096211014690. [PMID: 33985356 PMCID: PMC8127750 DOI: 10.1177/23247096211014690] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a sexual developmental disorder. In this disorder, there is a congenital absence of the uterus and vagina with normal external genitalia. The etiology is not well understood. Variations of this condition exist that may include congenital abnormalities and psychological problems. In this article, we discuss the case of a 47-year-old African American female who presented with acute renal failure, solitary right kidney, and a pelvic mass extending from the pelvis to the right hypochondrium determined to be a fibroid. The patient was managed by a multidisciplinary team, dialyzed, and planned for removal of the mass. While understanding the low probability of having fibroids without a uterus, fibroids should not be excluded from such patients. It is also important to consider the emotional and psychological well-being of such patients.
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De A, Jain A, Tripathi R, Nigam A. Complete Uterine Septum with Cervical Duplication and Longitudinal Vaginal Septum: An Anomaly Supporting Alternative Embryological Development. J Hum Reprod Sci 2020; 13:352-355. [PMID: 33627987 PMCID: PMC7879847 DOI: 10.4103/jhrs.jhrs_4_20] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/28/2020] [Accepted: 10/15/2020] [Indexed: 11/04/2022] Open
Abstract
The diagnosis and management of Mullerian abnormalities have revolutionized with the advent of magnetic resonance imaging, three-dimensional ultrasound, and endoscopic techniques. All the earlier unclassified abnormalities can now be classified as per the new European Society of Human Reproduction and Embryology 2013 nomenclature. The presence of complete uterine septum with cervical duplication and longitudinal vaginal septum reinforces the alternative theory of Mullerian development. The presence of this complex anomaly is discussed in the light of embryonic development along with management issues.
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Affiliation(s)
- Arpita De
- Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Science and Research, Jamia Hamdard, New Delhi, India
| | - Abhinav Jain
- Department of Radiology, Hamdard Institute of Medical Science and Research, Jamia Hamdard, New Delhi, India
| | - Reva Tripathi
- Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Science and Research, Jamia Hamdard, New Delhi, India
| | - Aruna Nigam
- Department of Obstetrics and Gynaecology, Hamdard Institute of Medical Science and Research, Jamia Hamdard, New Delhi, India
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Weisbrod TC, Stacy NI, Stedman NL, Norton TM. Diagnosis and Surgical Management of a Paratesticular Cyst in a Rehabilitating Juvenile Male Green Turtle ( Chelonia mydas). Front Vet Sci 2020; 7:69. [PMID: 32175336 PMCID: PMC7056697 DOI: 10.3389/fvets.2020.00069] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/28/2020] [Indexed: 11/15/2022] Open
Abstract
A juvenile green turtle (Chelonia mydas) undergoing rehabilitation for cold stunning exhibited an asymmetric bulging of the left caudal plastron and was diagnosed with a large intra-coelomic mass based on radiographical findings. Ultrasonography further identified a fluid-filled structure within the caudal coelom. Cytological evaluation of fluid obtained from the structure was consistent with a transudate, and thus, a cyst of unknown origin was suspected. Computed tomography imaging was pursued to further characterize the extent and location of the mass, which occupied ~50% of the total coelomic cavity volume. Conservative management with monitoring and occasional drainage of the mass did not result in improvements; thus, an exploratory laparoscopy for further investigation and surgical planning was elected. Intra-coelomic surgery was performed to remove a thick-walled cystic mass associated with the left gonad. Histopathology confirmed a paratesticular cyst continuous with, and possibly originating from, the epididymis. Post-surgical recurrence of the cyst was not appreciated, and the animal was successfully released 1 year after admission. Unrelated to the cyst, the turtle developed acute severe anemia on two occasions throughout rehabilitation that responded to modification of antimicrobial treatment and subsequent steroid administration. To the authors' knowledge, this is the first report of a paratesticular cyst in a reptile.
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Affiliation(s)
- Tatiana C Weisbrod
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | - Nicole I Stacy
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States
| | | | - Terry M Norton
- Georgia Sea Turtle Center/Jekyll Island Authority, Jekyll Island, GA, United States
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5
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Cunha GR, Sinclair A, Ricke WA, Robboy SJ, Cao M, Baskin LS. Reproductive tract biology: Of mice and men. Differentiation 2019; 110:49-63. [PMID: 31622789 PMCID: PMC7339118 DOI: 10.1016/j.diff.2019.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022]
Abstract
The study of male and female reproductive tract development requires expertise in two separate disciplines, developmental biology and endocrinology. For ease of experimentation and economy, the mouse has been used extensively as a model for human development and pathogenesis, and for the most part similarities in developmental processes and hormone action provide ample justification for the relevance of mouse models for human reproductive tract development. Indeed, there are many examples describing the phenotype of human genetic disorders that have a reasonably comparable phenotype in mice, attesting to the congruence between mouse and human development. However, anatomic, developmental and endocrinologic differences exist between mice and humans that (1) must be appreciated and (2) considered with caution when extrapolating information between all animal models and humans. It is critical that the investigator be aware of both the similarities and differences in organogenesis and hormone action within male and female reproductive tracts so as to focus on those features of mouse models with clear relevance to human development/pathology. This review, written by a team with extensive expertise in the anatomy, developmental biology and endocrinology of both mouse and human urogenital tracts, focusses upon the significant human/mouse differences, and when appropriate voices a cautionary note regarding extrapolation of mouse models for understanding development of human male and female reproductive tracts.
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Affiliation(s)
- Gerald R Cunha
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA; George M. O'Brien Center of Research Excellence, Department of Urology, University of Wisconsin, Madison, WI, 93705, USA; Department of Pathology, Duke University, Davison Building, Box 3712, Durham, NC, 27710, USA.
| | - Adriane Sinclair
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Will A Ricke
- George M. O'Brien Center of Research Excellence, Department of Urology, University of Wisconsin, Madison, WI, 93705, USA
| | - Stanley J Robboy
- Department of Pathology, Duke University, Davison Building, Box 3712, Durham, NC, 27710, USA
| | - Mei Cao
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
| | - Laurence S Baskin
- Department of Urology, University of California, 400 Parnassus Avenue, San Francisco, CA, 94143, USA
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6
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Saatcioglu HD, Kano M, Horn H, Zhang L, Samore W, Nagykery N, Meinsohn MC, Hyun M, Suliman R, Poulo J, Hsu J, Sacha C, Wang D, Gao G, Lage K, Oliva E, Morris Sabatini ME, Donahoe PK, Pépin D. Single-cell sequencing of neonatal uterus reveals an Misr2+ endometrial progenitor indispensable for fertility. eLife 2019; 8:46349. [PMID: 31232694 PMCID: PMC6650247 DOI: 10.7554/elife.46349] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 02/25/2019] [Accepted: 06/24/2019] [Indexed: 12/16/2022] Open
Abstract
The Mullerian ducts are the anlagen of the female reproductive tract, which regress in the male fetus in response to MIS. This process is driven by subluminal mesenchymal cells expressing Misr2, which trigger the regression of the adjacent Mullerian ductal epithelium. In females, these Misr2+ cells are retained, yet their contribution to the development of the uterus remains unknown. Here, we report that subluminal Misr2+ cells persist postnatally in the uterus of rodents, but recede by week 37 of gestation in humans. Using single-cell RNA sequencing, we demonstrate that ectopic postnatal MIS administration inhibits these cells and prevents the formation of endometrial stroma in rodents, suggesting a progenitor function. Exposure to MIS during the first six days of life, by inhibiting specification of the stroma, dysregulates paracrine signals necessary for uterine development, eventually resulting in apoptosis of the Misr2+ cells, uterine hypoplasia, and complete infertility in the adult female. In the womb, mammals possess all of the preliminary sexual structures necessary to become either male or female. This includes the Mullerian duct, which develops into the Fallopian tubes, uterus, cervix, and vagina in female fetuses. In male fetuses, the testis secretes a hormone called Mullerian inhibiting substance (MIS). This triggers the activity of a small group of cells, known as Misr2+ cells, that cause the Mullerian duct to degenerate, preventing males from developing female sexual organs. It was not clear what happens to Misr2+ cells in female fetuses or if they affect how the uterus develops. Saatcioglu et al. now show that in newborn female mice and rats, a type of Misr2+ cell that sits within a thin inner layer of the developing uterus still responds to MIS. At this time, the uterus is in a critical early period of development. Treating the mice and rats with MIS protein during their first six days of life eventually caused the Misr2+ cells to die. The treatment also prevented a layer of connective tissue, known as the endometrial stroma, from forming in the uterus. As a result, the mice and rats were infertile and had severely underdeveloped uteri. While the Misr2+ cells are present in newborn rats and mice, Saatcioglu et al. found that they disappeared before birth in humans. However, the overall results suggest that Misr2+ cells act as progenitor cells that develop into the cells of the endometrial stroma. Future work could investigate the roles these cells play in causing uterine developmental disorders and infertility disorders. Furthermore, the finding that MIS inhibits the Misr2+ cells could help researchers to develop treatments for uterine cancer and other conditions where the cells of the uterus grow and divide too much.
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Affiliation(s)
- Hatice Duygu Saatcioglu
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
| | - Motohiro Kano
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
| | - Heiko Horn
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States.,Stanley Center, Broad Institute of MIT and Harvard, Cambridge, United States
| | - Lihua Zhang
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
| | - Wesley Samore
- Department of Pathology, Massachusetts General Hospital, Boston, United States
| | - Nicholas Nagykery
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
| | - Marie-Charlotte Meinsohn
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
| | - Minsuk Hyun
- Department of Neurobiology, Harvard Medical School, Boston, United States
| | - Rana Suliman
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
| | - Joy Poulo
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States.,Stanley Center, Broad Institute of MIT and Harvard, Cambridge, United States
| | - Jennifer Hsu
- Department of Gynecology and Reproductive Biology, Massachussets General Hospital, Boston, United States
| | - Caitlin Sacha
- Department of Gynecology and Reproductive Biology, Massachussets General Hospital, Boston, United States
| | - Dan Wang
- Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester, United States
| | - Guangping Gao
- Horae Gene Therapy Center, University of Massachusetts Medical School, Worcester, United States
| | - Kasper Lage
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States.,Stanley Center, Broad Institute of MIT and Harvard, Cambridge, United States
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, United States
| | - Mary E Morris Sabatini
- Department of Gynecology and Reproductive Biology, Massachussets General Hospital, Boston, United States
| | - Patricia K Donahoe
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
| | - David Pépin
- Pediatric Surgical Research Laboratories, Massachusetts General Hospital, Boston, United States.,Department of Surgery, Harvard Medical School, Boston, United States
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7
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Chon SH, Im UJ, Song DS. Paravertebral mediastinal Mullerian cyst resected by video assisted thoracoscopic surgery. J Thorac Dis 2015; 7:E47-9. [PMID: 25922749 DOI: 10.3978/j.issn.2072-1439.2014.12.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/26/2014] [Indexed: 11/14/2022]
Abstract
Ever since Hattori et al. had described the mediastinal Mullerian cyst in 2005 there has been several new cases described in the literature. We report a 51-year-old woman with an incidentally found 2 cm × 3 cm mass in her left paravertebral mediastinum. She underwent thoracoscopic removal with the impression of a neurogenic tumor and was unexpectedly found with a ciliated cyst of Mullerian origin.
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Affiliation(s)
- Soon-Ho Chon
- 1 Department of Thoracic and Cardiovascular Surgery, 2 Department of Anesthesiology, S-Jungang Hospital, Jeju, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Wonkwang University Sanbon Hospital, Gunpo, South Korea
| | - Ui Jae Im
- 1 Department of Thoracic and Cardiovascular Surgery, 2 Department of Anesthesiology, S-Jungang Hospital, Jeju, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Wonkwang University Sanbon Hospital, Gunpo, South Korea
| | - Dong Seop Song
- 1 Department of Thoracic and Cardiovascular Surgery, 2 Department of Anesthesiology, S-Jungang Hospital, Jeju, South Korea ; 3 Department of Thoracic and Cardiovascular Surgery, Wonkwang University Sanbon Hospital, Gunpo, South Korea
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9
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Tayyebi Meibodi N, Mahdavi R, Montazer M. Large pelvic cystic mass of mullerian duct origin with involvement of rectal wall: a case report. Iran Red Crescent Med J 2011; 13:149-50. [PMID: 22737454 PMCID: PMC3371917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 10/10/2010] [Accepted: 10/25/2010] [Indexed: 11/16/2022]
Affiliation(s)
- N Tayyebi Meibodi
- Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence: Naser Tayyebi Meibodi, MD, Associate Professor of Pathology, Imam-Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Tel.: +98-511-8022234, Fax: +98-511-8591057, E-mail:
| | - R Mahdavi
- Department of Urology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M Montazer
- Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran
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