Müllerian anomalies "without a classification": from the didelphys-unicollis uterus to the bicervical uterus with or without septate vagina. 2009

Pedro Acién, and Maribel Acién, and M Luisa Sánchez-Ferrer
Service of Obstetrics and Gynecology, University Hospital of San Juan, Department/Division of Gynecology, Miguel Hernández University, Campus of San Juan, Alicante, Spain. acien@umh.es

OBJECTIVE To point out possible discrepancies in the classic hypothesis of Müllerian development and to present cases that support an alternative hypothesis. METHODS Case reports. METHODS University hospital. METHODS Six women with uterine malformation. METHODS Surgical, clinical, and outpatient evaluation of the anomalies. METHODS Assessment of the genital anomalies according to our embryologic investigations and embryologic-clinical classification and standard classifications for Müllerian malformations. RESULTS We have included examples of cases presenting with didelphys uterus with normal cervix, didelphys uterus with septate cervix, and bicornuate (or didelphys) uterus with septate cervix and vagina versus septate uterus with double cervix and vagina, septate bicervical uterus with isthmic communication, and normal simplex uterus with septate cervix and vagina. CONCLUSIONS These case reports prove that the fusion and reabsorption processes in the development of the Müllerian ducts can be affected to different degrees in the superior-convergent and inferior-divergent portions, thus resulting in atypical or transitional cases without a classification. Therefore, for a more appropriate classification of the uterine malformations, even if the same degrees of fusion, resorption, and development defects are used, a separate classification should be made for each superior and inferior uterine segment.

UI MeSH Term Description Entries
D007044 Hysterectomy Excision of the uterus. Hysterectomies
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009095 Mullerian Ducts A pair of ducts near the WOLFFIAN DUCTS in a developing embryo. In the male embryo, they degenerate with the appearance of testicular ANTI-MULLERIAN HORMONE. In the absence of anti-mullerian hormone, mullerian ducts give rise to the female reproductive tract, including the OVIDUCTS; UTERUS; CERVIX; and VAGINA. Muellerian Duct,Mullerian Duct,Muellerian Ducts,Duct, Muellerian,Duct, Mullerian,Ducts, Muellerian,Ducts, Mullerian
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D002584 Cervix Uteri The neck portion of the UTERUS between the lower isthmus and the VAGINA forming the cervical canal. Cervical Canal of the Uterus,Cervical Canal, Uterine,Ectocervix,Endocervical Canal,Endocervix,External Os Cervix,External Os of the Cervix,Uterine Cervical Canal,Cervix,Cervixes,Uterine Cervix,Canal, Endocervical,Canal, Uterine Cervical,Cervix, External Os,Cervix, Uterine,Endocervical Canals,Uterine Cervical Canals
D002585 Cesarean Section Extraction of the FETUS by means of abdominal HYSTEROTOMY. Abdominal Delivery,Delivery, Abdominal,C-Section (OB),Caesarean Section,Postcesarean Section,Abdominal Deliveries,C Section (OB),C-Sections (OB),Caesarean Sections,Cesarean Sections,Deliveries, Abdominal
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000015 Abnormalities, Multiple Congenital abnormalities that affect more than one organ or body structure. Multiple Abnormalities
D000230 Adenocarcinoma A malignant epithelial tumor with a glandular organization. Adenocarcinoma, Basal Cell,Adenocarcinoma, Granular Cell,Adenocarcinoma, Oxyphilic,Adenocarcinoma, Tubular,Adenoma, Malignant,Carcinoma, Cribriform,Carcinoma, Granular Cell,Carcinoma, Tubular,Adenocarcinomas,Adenocarcinomas, Basal Cell,Adenocarcinomas, Granular Cell,Adenocarcinomas, Oxyphilic,Adenocarcinomas, Tubular,Adenomas, Malignant,Basal Cell Adenocarcinoma,Basal Cell Adenocarcinomas,Carcinomas, Cribriform,Carcinomas, Granular Cell,Carcinomas, Tubular,Cribriform Carcinoma,Cribriform Carcinomas,Granular Cell Adenocarcinoma,Granular Cell Adenocarcinomas,Granular Cell Carcinoma,Granular Cell Carcinomas,Malignant Adenoma,Malignant Adenomas,Oxyphilic Adenocarcinoma,Oxyphilic Adenocarcinomas,Tubular Adenocarcinoma,Tubular Adenocarcinomas,Tubular Carcinoma,Tubular Carcinomas

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