Mullerian Duct Anomalies - edurad.com
Transcript of Mullerian Duct Anomalies - edurad.com
Mullerian Duct Anomalies
- By Dr. Poonam J NerlekarRadiology Resident (1styr),
Holy Spirit Hospital, Andheri (E), Mumbai.
Embryology of the ovaries and vagina
• Ovaries develop from a gonadal ridge• Bottom third of vagina develops from the urogenital sinus
– Following this, there is fusion of upper 2/3 and lower 1/3 of vagina with degeneration of transverse septum
• Rupture of the hymen at birth
Stage 1 – Weeks 6 to 7• Stage one:
– The two separate endometrial, cervical and vaginal components
Normal
• Arrest in stage 1: Non-development– Agenesis or hypoplasia
• Class I
– Unicornuate• Class II• 20%
• 10%
Stage Two – Weeks 10 to 13• By the end of stage two:
– The two tubes fuse
Normal
• Arrest in stage 2: Non-fusion– Didelphys: complete non-fusion
• Class III
– Bicornuate: partial non-fusion• Class IV
• 5% of MDA• 75% assoc.
w/ vag septum
• 10%• 25% assoc.
w/ vag septum
Stage Three – Weeks 13 to 20 • The midline portions dissolve
Normal
• Arrest in stage 3: Non-degeneration– Septate and arcuate
• Class V and VI
• 55%• May be assoc.
w/ vag septum
CLASS II UNICORNUATE UTERUS
• There is failure of one Mullerian duct to elongate while the other develops normally. It may or may not have rudimentary horn.
CLASS III UTERUS DIDELPHYS
• there is complete duplication of uterine horns as well as duplication of the cervix, with no communication between them.
CLASS IV BICORNUATE UTERUS
• There is partial failure of fusion of the ducts.
1) Bicornuate bicollis2) Bicornuate
unicollis
CLASS V SEPTATE UTERUS
• Results from partial or complete failure of resorption of the uterovaginalseptum after fusion of the ducts
CLASS VI ARCUATE UTERUS
• There is mild indentation of the endometrium at the uterine fundus as the result of near complete resorption of the uterovaginal septum.
CLASS VII T SHAPED UTERUS
• It is the most commonly associated abnormality from in utero diethylstilbestrol (DES) exposure
ASSOCIATED ANOMALIES
• RENAL AGENESIS / RENAL ECTOPIA
• SKELETAL ABNORMALITIES = SCOLIOSIS
• MAYER ROKITANKSY KUSTER – HAUSER SYNDROME
• ABSENCE OR HYPOPLASIA OF VAGINA
References:-• Troiano, R. Mullerian Duct Anomalies: Imaging and Clinical Issues.
Radiology. 2004;233(1):19-34.• Grimbizis GF. Congenital malformations of the female genital tract:. Fertil
Steril. 2010;94(2):401-407.• Simon C, Martinez L, Pardo F, et al. Mullerian defects in women with
normal reproductive outcome. Fertil Steril. 1991;56(6):1192-3.• Agrawal, G. et al. Evaluation of Uterine Anomalies: 3D FRFSE Cube versus
Standard 2D FRFSE. Am. J. Roentgenol. 2009;193:558-562.• Troiano, R. Mullerian Duct Anomalies: Imaging and Clinical Issues.
Radiology. 2004;233(1):19-34• Gray, Henry (1858), Anatomy Descriptive and Surgical, London: John W.
Parker and Son, retrieved 16 October 2011 Online- and PDF versions of the 1st edition at Open Library/Internet Archive.