Adenomyosis in a noncommunicating rudimentary horn of unicornuate uterus - a diagnostic dilemma

摘要

The prevalence of congenital uterine malformations is about 0.5%.Unicornuate uterus is a rare anomaly of the female internal genitalia (2.5-13%) [1]. Partial development of one of the mullerian ducts may result in anomalies in various combinations whereby one of the horns may remain rudimentary with or without any communication with its fellow [1]. Complications related to this condition are related to its presentation during different phases of life of a woman. We present a case of adenomyosis in the noncommunicating laterally displaced rudimentary horn which gave us a primary impression of solid ovarian tumor. Case Report A 45 year old woman, Para 2, presented with a lump in her lower abdomen which had increased in size since past 18 months. She had regular menstrual cycles but felt pain in the lower abdomen as well as in the low back region during menses. There was no significant loss of weight or alteration of bladder or bowel habits. She had borne three children vaginally. In her first pregnancy she had pregnancy induced hypertension and delivered breech vaginally. Her second pregnancy was uneventful but she had an intrauterine fetal death (IUFD) at term in her third pregnancy. She is a short statured woman (4ft 9 in) and clinical examination revealed a large and firm smooth surfaced, non-tender lump of about 16 weeks gravid uterine size arising from the pelvis without any restriction in mobility. The lower pole could be delineated with ease. There was no evidence of free fluid in the peritoneal cavity. Vaginal examination revealed uterus and left adnexa normal, and on the right a firm mobile mass consistent with the abdominal examination. USG of whole abdomen revealed a mass on the right side with normal uterus and left ovary. Right ovary could not be seen and the final impression was either a subserous fibroid or an ovarian tumor. There was no abnormality in renal tract.Laparotomy was performed through Pfanenstiel incision. A mass (about 12 x 15cm.) was seen attached to the horn of the unicornuate uterus on left side. Round ligament, tube and ovary was attached to the left side. Right ovary and tube was seen separately connected to the solid mass but the round ligament on this side was obscured probably due to stretch. Both tubes and ovaries looked healthy. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The specimen was thoroughly studied postoperatively [Fig 1, Fig 2] and cut open to identify the cavity in both the mass and the uterus. The cut surface of the mass showed scattered areas of tiny hemorrhagic spots [Fig 3].