Fetal hydrometrocolpos, uterus didelphys with low vaginal and anal atresia: difficulties in differentiation from a complex cloacal malformation: a case report.

Hydrometrocolpos, occurring in approximately 1/6000 newborn girls, can be caused by a stenotic urogenital sinus, a severe cloacal malformation, but also by other conditions such as an imperforate hymen, a midline vaginal septum and vaginal atresia. The prenatal differential diagnosis of this wide spectrum of conditions is not easy and requires a multidisciplinary approach with follow-up scans and MRI to access the severity of the condition. A non-consanguineous couple was referred in the first pregnancy at 30 weeks. The father, 30 years of age, of Kaukasian origin, and the mother of Asian origin, 26 years of age. Ultrasound at 30 weeks revealed ambiguous genitalia (with suspicion of clitoral hypertrophy), a septated structure located behind the bladder compatible with hydrometrocolpos with a uterine malformation (uterus didelphys), a single umbilical artery, mild ascites and growth on the tenth centile. The differential diagnosis included a vaginal atresia, a urogenital sinus and a more severe cloacal malformation. After serial scans, MRI and counselling by an experienced surgeon the preferential diagnosis of a cloacal malformation was made and a late pregnancy termination was performed. Pathological examination revealed: low vaginal atresia with uterus didelphys, anal atresia with rectovaginal fistula and a normal urinary tractus. The differential diagnosis between hydrometrocolpos due to vaginal atresia or due to a more severe cloacal malformation is not straightforward. Care should be taken in decision making and counselling patients with these complex prenatal malformations.

Benign masses of the female periurethral tissues and anterior vaginal wall.

Due to their rarity, benign masses of the periurethral tissues and anterior vaginal wall are poorly understood. Arriving at the proper evaluation and treatment is challenging because many of these masses have similar presenting signs and symptoms, as well as overlapping differential diagnoses. The literature regarding these lesions mainly consists of level III evidence, mostly involving case reports and series. Clinical management has traditionally been based on established surgical principles and expert opinion. This review presents the pertinent embryologic and anatomic background for these benign masses, as well as other pertinent etiological processes. Furthermore, the most current evidence is reviewed regarding the differential diagnosis, evaluation, and treatment for each mass.

Clinical diagnosis of vaginal adenosis.

PIP: The increased incidence of vaginal adenosis in young girls whose mot hers were given diethylstilbestrol (DES) during pregnancy has heightened the interest and clinical awareness of this teratogenic process. In these cases, exfoliative cytology is usually negative and Schiller's iodine test is imprecise. Examinations were made of 63 young women (12-23 years old) whose mothers had been given DES during the first trimester of pregnancy. 55 were asymptomatic, 6 had noticed a mucus vaginal discharge, 2 had complained of dyspareunia, and none had been pregnant. Cytology of 3 was atypical. In 24, the usual gynecological examination was reported as normal. In 7, a lesion suggesting adenosis had been observed. Visual examination of the cervix and vagina revealed 3 with atypical gross findings. A circular fold in the vaginal fornices partially covered the cervix in 9 cases. Cervical irregularity was observed in another 9 cases. Erythroplakia (reddish brown areas on the cervix or vagina) seen in 8 patients represented columnar epithelium inflammation, or neoplasia. Gross inspection did not determine the pathology. In 41 (71 percent) gross examination of the cervix and vagina failed to reveal any changes. By colposcopic examination columnar epithelium on the surface of the vagina was found in 24 cases (38 percent). After the acetic acid test, grapelike structures of columnar epithelium were visible. In 57 patients (91 percent), columnar epithelium was found in the vaginal wall; these were classified as vaginal adenosis. In 6 patients, the columnar epithelium was seen only on the periphery of the cervix. The incidence of vaginal adenosis seems to correlate directly with methods of detection as most cases are asymptomatic. The diagnosis is difficult to establish by conventional clinical methods. Colposcopic examination was an accurate method, particularly in cases which were not apparent by other methods. Biopsies may be needed also.^ieng

Embryological implications of partial Müllerian agenesis with vaginal adenosis. A case report.

The finding of adenosis in the vaginal pouch of a patient with agenesis of th lower Müllerian tract suggests that not all cases of vaginal adenosis are Müllerian in origin.

[Neonatal hydrometrocolpos. A cause of immediate neonatal respiratory distress]. / Hydrométrocolpos néonatal. Une cause de détresse respiratoire immédiatement néonatale.

The authors report a case of acute fetal distress and immediate respiratory distress in a neonate presenting with large hydrometrocolpos. This diagnosis, infrequently concerned in such a situation, should be suggested in cases with abdominal tumors.

Cysts of the female external genitalia in the newborn infant.

Nineteen cases of cysts of the external female genitalia were diagnosed over a two-year period, giving an incidence of six per 1,000 female infants. The embryology, morphology, and differential diagnosis are discussed. No treatment was given and follow-up at two months of age revealed complete resolution of the cysts, thereby establishing their benign course in the newborn period.

Developmental retroperitoneal cysts of the pelvis. A review.

Retroperitoneal cysts have been classified into traumatic, infective, degenerative, neoplastic, and developmental, according to their origin. This paper focuses on the developmental variety of retroperitoneal pelvic cysts, particularly those of mesothelial, mesonephric, or paramesonephric origin. Their clinical presentations depend on their location; they may be mesenteric, parovarian, or vaginal. The pathogenesis and embryologic, diagnostic, and therapeutic aspects are reviewed and a case report is presented.

Single ectopic ureter inserting into a duplicated imperforate hemivagina: a rare cause of a fetal abdominal mass.

We present a unique case of obstructed vaginal duplication with ectopic ureteral drainage of an ectopic dysplastic kidney presenting as an antenatal diagnosis of a pelvic mass.