Application of Saline Infusion Sonocolpography in Diagnosis and Treatment of Perforated Transverse Vaginal Septum.

Transverse vaginal septum (TVS) is a particularly rare vaginal anomaly, and diagnosis is often difficult in a genital examination. We herein present a case of perforated TVS for which successful diagnosis and treatment were achieved using a new technique referred to as saline infusion sonocolpography. A 32-year-old female presented with primary infertility. Speculum examination revealed a blind vaginal canal with two pinpoint perforating holes. Foley catheters with inflated balloon were inserted into the two apertures, and then normal saline was injected through the catheters to distend the vaginal pouch. This procedure of saline infusion sonocolpography revealed the uterine cervix and vaginal pouch and permitted diagnosis of perforated TVS of the upper vagina. The septum was excised and a normal cervix was ascertained. The patient had no complication such as agglutination of the vagina postoperatively. This case suggests that saline infusion sonocolpography may be useful for diagnosis and treatment of TVS.

Mayer-Rokitansky-Küster-Hauser syndrome with a uterine cervix and normal vagina associated with gonadal dysgenesis in a 46,XX female.

Coexistence of Mayer-Rokitansky-Küster-Hauser syndrome and gonadal dysgenesis is extremely rare, and a case of Mayer-Rokitansky-Küster-Hauser syndrome with a uterine cervix and normal vagina has not been reported. Here, we report such a case associated with gonadal dysgenesis. A 17-year-old female presented with primary amenorrhea and undeveloped secondary sexual characteristics. Genital examination revealed a uterine cervix and normal vagina without a uterine body and ovaries. An endocrine study showed hypergonadotrophic hypogonadism. The karyotype was 46,XX. Laparoscopy revealed a rudimentary uterus, normal fallopian tubes and bilateral streak ovaries. There were no other associated malformations. Hormonal substitution therapy was started for development of secondary sexual characteristics and prevention of osteoporosis, but the problem of infertility is unresolved.

Clear cell carcinoma of the lower uterine segment: A case report.

Uterine carcinoma of the lower uterine segment (LUS) is a rare tumor that accounts for 3-3.5% of cases of uterine malignant cancer. The tumor arises from the lower region of the uterine body through the upper region of the cervix. The present study reported a case of clear cell carcinoma that originated from the LUS. A 50-year-old woman visited a local hospital due to irregular vaginal bleeding. She was suspected to have a uterine tumor and was referred to Tachikawa Hospital (Tokyo, Japan). Transvaginal ultrasound and magnetic resonance imaging revealed a uterine tumor from the lower region of the uterine body through the upper region of the cervix. Endocervical curettage revealed clear cell carcinoma. Based on a diagnosis of clear cell carcinoma of the LUS, radical hysterectomy was performed with bilateral salpingo-oophorectomy, paraaortic lymph node dissection and omentectomy. Macroscopically, the tumor was limited to the lower region of the uterine body through the upper region of the cervix in the resected uterus. Histopathological findings indicated no tumors in the uterine corpus and uterine cervix, but clear cell carcinoma was observed in the LUS epithelium. At the 1-year follow-up, the patient remained free of local recurrence and metastasis. To the best of our knowledge, clear cell carcinoma of the LUS has not previously been reported. More cases are required to clarify the pathology.