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Knowledge Area 11: Subfertility
Published in Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth, Get Through MRCOG Part 1, 2020
Rekha Wuntakal, Ziena Abdullah, Tony Hollingworth
There are two mesonephric ducts (Wolffian duct system) and two paramesonephric ducts (Müllerian duct system) in the body during embryonic development of the reproductive organs. The paramesonephric duct arises from the invagination of the epithelium covering the urogenital ridge on the anterolateral surface. It opens cranially into the abdominal cavity. Caudally, it lies lateral to the mesonephric duct before crossing it ventrally. It then lies medial to the mesonephric duct. Further to this, it joins the opposite paramesonephric duct in the midline and forms the uterine cavity. In females, the paramesonephric duct gives rise to the uterus, fallopian tubes, cervix, upper third of the vagina (lower two-thirds of the vagina develop from urogenital sinus) and a vestigial or rudimentary structure called Morgagni hydatid. In males, it forms the vestigial structure called the appendix of testis.
Effects on Female Offspring and Mothers After Exposure to Diethylstilbestrol
Published in Takao Mori, Hiroshi Nagasawa, Toxicity of Hormones in Perinatal Life, 2020
J. Rotmensch, K. Frey, A. L. Herbst
An understanding of the histogenesis of the human lower genital tract may help in the interpretation of clinical changes seen due to the transplacental passage of DES early in pregnancy. CCA associated with DES is believed to be Mullerian in origin rather then mesonephric (Figure 9). The Mullerian system arises from the paramesonephric duct during embryogenesis. At 6 weeks, a fetus develops a Mullerian cleft in the pronephric duct. A tip of the mesothelial cells then splits off and develops the Mullerian ducts. At 8 weeks of development, the Mullerian ducts proceed caudally and meet at the urogenital sinus. During the 12th through 16th weeks of fetal development, the two Mullerian ducts fuse and begin to proceed cranially to the ligamentum vaginale (round ligament) forming the precursors of the uterus and upper vagina. The midline fusion and canalization of the Mullerian ducts are completed by the 16th week. A squamous thickening and vaginal plate forms at the urogenital sinus which ultimately folds in to form the lower vagina. When the plate opens into the fused Mullerian ducts, the canalization has been completed.48-52
The female reproductive system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
During fetal development, the germ cells migrate from the yolk sac through the dorsal mesentery to lie within the indifferent gonads, which differentiate in the female to form the ovaries. In the absence of surviving germ cells, e.g. in Turner's syndrome, the gonads fail to differentiate but rather form ‘streak’ gonads. In the absence of regressive stimuli, the paired paramesonephric (Müllerian) ducts form the fallopian tubes and, by fusion, the uterus, cervix, and upper vagina. The lower vagina is derived from the urogenital sinus. If the process of paramesonephric duct fusion is abnormal, a variety of fusion defects can occur; these are important because they are associated with infertility and obstetric complications.
MRI image features and differential diagnoses of Herlyn–Werner–Wunderlich syndrome
Published in Gynecological Endocrinology, 2020
Jinlong Zhang, Shengfang Xu, Lei Yang, Yue Songhong
HMMS is caused by abnormal partial fusion of the bilateral paramesonephric duct with the low incidence of 0.1–3.8% [1–4], and the embryonic development is as a hot topic for research throughout the world. Its main characteristics are a double uterus, double cervix, and double vagina and complete or incomplete atresia of one vagina. HMMS is often accompanied by an oblique septum side kidney and ureter agenesis or other syndromes characterized by genitourinary malformations. The mesenchyme–mesoderm structure becomes the urogenital ridge at about the fifth week of embryonic development, and the mesonephric and Mullerian ducts are gradually formed. For females, the former develops into the urinary system, while the latter develops into the reproductive system. The development of the Mullerian ducts depends on that of the mesonephric duct. When one side of the mesonephric duct is not fully developed because of various factors, development of the ipsilateral Mullerian duct will be affected, which can result ina series of deformities of the kidney, ureter, uterus, and vagina [3–8]. Abnormal muller's disease will lead to infertility, frequent abortion, premature rupture of placenta, premature rupture of fetal membrane, placenta retention, postpartum hemorrhage, fetal abnormal performance, intrauterine growth restriction, increased fetal mortality and other obstetric complications. Recent cases of HWWS complicated with spontaneous abortion, fetal abnormality and premature birth have been reported.
Acute abdominal pain due to internal herniation of the sigmoid colon, fallopian tube and left ovary, a rare presentation of Allen Masters syndrome
Published in Acta Chirurgica Belgica, 2019
C. H. Mazzetti, N. Hock, S. Taylor, J. Lemaitre, K. Crener, E. Lebrun
Herniation through a defect in the broad ligament was firstly reported by Quain in 1861 [3], in an autopsy series. Cilley classified broad ligaments defects in three categories in function of the site of laceration: type 1, the most common, occurs between fallopian tube and round ligament; type 2 between fallopian tube and ovary and type 3 between round ligament and uterus [4]. Hunt describes another type of hernia classification: fenestra type that involves a complete fenestration through both peritoneal layers, hernia sac is absent and the herniation is located lateral to the uterus and pouch type that involves only one of the layers, anterior or posterior, the herniation comes with a sac [5,6]. In female embryos, broad ligament origin from fusion of the paramesonephric ducts, but the physiopathology in congenital forms remains unknown. In nulliparous patients, it has been hypothesized that defect can result from spontaneous rupture of cystic structures remnants of mesonephric or mulleran ducts [4]. Acquired forms on the contrary seem to be due to trauma resulting from pregnancy or delivery (80% of cases have been identified in multiparous women), surgery, endometriosis or pelvic inflammatory disease [7,8].
Adenomyosis and infertility: the role of the junctional zone
Published in Gynecological Endocrinology, 2021
Chiara Barbanti, Gabriele Centini, Lucia Lazzeri, Nassir Habib, Luca Labanca, Errico Zupi, Karolina Afors, Antonella Clara Starace
Adenomyosis (AD) is a benign uterine disorder characterized by the presence of endometrial glands and stroma within the myometrium surrounded by hyperplastic smooth muscle cells [1]. The invasion of the endometrium within the myometrium seems to start from the junctional zone (JZ), the inner myometrium, with a self-perpetuation process through the TIAR (tissue injury and repair) system. Hyperestrogenism may enhance endometrial proliferation and hyperperistalsis-induced tissue microtrauma in the JZ, which actives the TIAR mechanism; this system, contributing to the increase production of estrogens, induces chronic hyperperistalsis in the JZ and so repeated cycles of autotraumatization, which inhibit the healing process, increase invagination of the endometrium in the myometrium and the development of adenomyotic lesions through a positive feedback mechanism [2]. The JZ is a hormone-dependent, highly specialized uterine compartment, with different structural and biological characteristics respect to the outer myometrium [3]. Estrogen and progesterone receptors are present in both outer and inner myometrium, but only the latter one has steroid receptors following cyclical changes [4]. The similarity between endometrium and JZ seems to be embryological; Noe et al. found that the endometrium and the inner myometrium originates from paramesonephric duct, while the outer myometrium originates from non-paramesonephric mesenchymal tissues, and these embryological differences leads to different functions. The JZ plays an important role in sperm transport, implantation and placentation, while the outer myometrium contractility participates in the labor process [5].