Académique Documents
Professionnel Documents
Culture Documents
Female Male
G. ridge Ovary Testis
G. swelling Labia majora Scrotum
G. fold Labia minora Penile urethra
Gubernaculum Round lig. & ov. ligament Gubernaculum testis
Mesonephric Duct Gartener duct Vas deferens
Pelvic UGS Skene's gland Prostate
The Wolffian remnants in the female
in female, the wolffian ducts
undergo atrophy leaving remnants
between two layers of B.L. and in
the anterolateral wall of the vagina
These remnants are:
Hydated cyst of morgagni: lateral
to the tube
Koblet's tubules: in the outer part
of B.L.
Epoophoron: between the ovary
and F.T
Paroophoron: between the ovary
and uterus.
Gartener's duct: may undergo
cystic dilatation in the B.L. gives
rise to paraovarian cyst or in the
anterolateral wall of the vagina,
gives rise to Gartener's cyst
Congenital anomalies of
reproductive tract
The Mullerian and wolffian ducts are closely related
embryologically, so, the association between the
genital & urinary system anomalies is common.
Malformations of genital tract may be represented by:
aplasia ‑ atresia ‑ hypoplasia -fusion defects or
duplication of accessory organs.
Complete formation and differentiation of the
mullerian ducts into the segments of the female
reproductive tract depend on completion of 3 phases
of development as follows:
Organogenesis
Fusion
Septal resorption
Congenital anomalies of
).reproductive tract )cont
Organogenesis: One or both Mulllerian ducts may not develop fully,
resulting in abnormalities such as uterine agenesis or hypoplasia
(bilateral) or unicornuate uterus
Fusion:
The process during which the lower segments of the paired
Mullerian ducts fuse to form the uterus, cervix, and upper vagina is
termed lateral fusion. Failure of fusion →bicornuate or didelphys
uterus.
The term vertical fusion occasionally is used to refer to fusion of the
ascending sinovaginal bulb with the descending Mullerian system
(ie, fusion of the lower 1/4and upper ¾ of the vagina). Complete
vertical fusion forms a normal patent vagina, while incomplete
vertical fusion results in an imperforate hymen.
Septal resorption: after the lower Mullerian ducts fuse, a central
septum is present, which subsequently must be resorbed to form a
single uterine cavity and cervix.
Failure of resorption is the cause of septate uterus.
Internal structures anomalies
Mullerian duct anomalies are categorized
most commonly into 7 classes according to
the American Fertility Society (AFS)
Classification Scheme (1988) as follows:
Class I (hypoplasia/agenesis):
Uterine/Cervical agenesis or hypoplasia.
The most common form is the
Mayer‑Rokitansky‑Kuster Hauser syndrome,
which is combined agenesis of the uterus,
cervix, and upper portion of the vagina.
Patients have no reproductive potential.
)Class II )unicornuate uterus
Complete, or almost complete,
arrest of development of one
Mullerian duct. If the arrest is
incomplete, as in 90% of patients, a
rudimentary horn with or without
functioning endometrium is present.
If the rudimentary horn is obstructed,
it may come to surgical attention
when presenting as an enlarging
pelvic mass. If the contralateral
healthy horn is almost fully
developed, a full‑term pregnancy is
believed to be possible
)Class III )didelphys uterus
Results from complete non-
fusion of both Mullerian ducts
The individual horns are fully
developed and almost normal in
size.
Two cervices are inevitably
present.
A longitudinal or transverse
vaginal septum may be noted as
well.
Since each horn is almost a fully
developed uterus, patients have
been known to carry pregnancies
to full term.
Class IV))bicornuate uterus
Results from partial non fusion of the
Mullerian ducts .
The central myometrium may extend to the
level of the internal cervical os (bicornuate
unicollis) or ex ternal cervical os (bicornuate
bicollis). The latter is distinguished from
didelphys uterus because it demonstrates
some degree of fusion between the two
horns, while in classic didelphys uterus, the
two horns and cervices are separated
completely.
In addition, the horns of the bicornuate uteri
are not fully developed; typically, they are
smaller than those bicornuate
(bicollisunicollis(
Some patients are surgical candidates for
metroplasty of didelphys uteri
Class V))septate uterus
A septate uterus results from failure of resorption
of the septum between the two uterine horns.
The septum can be partial or complete, in which
case it extends to the internal cervical os
Histologically, the septum may be composed of
myometrium or fibrous tissue.
The uterine fundus is typically convex but may be
flat or slightly concave (<1cm fundal cleft).
Women with septate uterus have the highest
incidence of reproductive complications.
Differentiation between a septate and a
bicornuate uterus is important because septate
uteri are treated using transvaginal hysteroscopic
resection of the septum, while if surgery is
possible and/or indicated for the bicornuate
uterus, an abdominal approach is required to
perform metroplasty
)Class VI )arcuate uterus
Arcuate uterus has a single
uterine cavity with the outer
contour of the uterus
convex or flat.
This form is often
considered a normal
variant since it is not
significantly associated
with the increased risks of
pregnancy loss and the
other complications found
in other subtypes.
Class
)anomaly
The uterine anomaly is seen in
the female offspring of as many
as 15% of women exposed to
DES during pregnancy.
Female fetuses who are affected
have a variety of abnormal
findings that include uterine
hypoplasia and a T‑shaped
uterine cavity.
Patients also may have abnormal
transverse ridges, hoods, stenosis
of the cervix, and adenosis of the
vagina with increased risk of
vaginal clear cell carcinoma.
Imaging findings are
pathognomonic for this anomaly.
Fallopian tube anomalies
Include:
aplasia,
atresia,
hypoplasia (very long & thin),
accessory horn or ostia and tubal
diverticulum
It may cause infertility or ectopic
pregnancy
Vaginal anomalies
Vaginal septa:
Longitudinal septa:
Partial or complete septa extending
antroposteriorly in the vagina results from
failure of disappearance of the fused Mullerian
structure, this may be associated with normal
uterus or duplicate uterus
Occasionally the septum may not be in the
midline and may not communicate externally
leading to lateral pouch containing menstrual
blood
Transverse vaginal septum
Complete or perforated
Rare occurs at the junction of upper and middle 1/3 of
vagina
Androgenic tumors