Mimics of malignancy caused by concurrent imperforate hymen and transverse vaginal septum: an instructive case and review of the literature

The coexistence of imperforate hymen and vaginal septum is rare and their ability to mimic malignant manifestations have not been frequently reported. This current case report describes a 13-year-old girl that presented with cyclic abdominal pain for 6 months. She was found to have a huge mass via abdominal plain film X-ray and sonography, with inexplicably high levels of serum carcinoembryonic antigen, cancer antigen (CA)-19-9 and CA-125. Pelvic computed tomography imaging disclosed two huge cystic lesions in the uterine and upper vaginal cavities. Surgical intervention conformed the diagnosis of a concurrent imperforate hymen and transverse vaginal septum, echoing the imaging findings of haematocolpometra. Her tumour marker levels gradually returned to normal after surgery. This rare case of concomitant imperforate hymen and transverse vaginal septum highlights that haematocolpometra, a benign disease that might mimic malignancy, should be taken into consideration in any adolescent females with an abdominal mass and amenorrhoea to ensure an early diagnosis and timely appropriate management.

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Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes

Japanese Journal of Radiology ◽

10.1007/s11604-021-01115-7 ◽

2021 ◽

Author(s):

Keizo Tanitame ◽

Nobuko Tanitame ◽

Saiko Urayama ◽

Kazuhiro Ohtsu

Keyword(s):

Correct Diagnosis ◽

Late Complications ◽

Diagnosis And Treatment ◽

Imaging Findings ◽

Vaginal Septum ◽

Renal Anomaly ◽

Imperforate Hymen ◽

Adequate Knowledge ◽

Transverse Vaginal Septum ◽

Urogenital Anomalies

AbstractHemato/hydrocolpos due to congenital urogenital anomalies are rare conditions discovered in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed owing to its rare incidence and nonspecific symptoms. If early correct diagnosis and treatment cannot be performed, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. Congenital urogenital anomalies causing hemato/hydrocolpos are mainly of four types: imperforate hymen, distal vaginal agenesis, transverse vaginal septum, and obstructed hemivagina and ipsilateral renal anomaly, and clinicians should have adequate knowledge about these anomalies. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.

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Müllerian Anomalies: A Cause for Primary Amenorrhea

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1499 ◽

2017 ◽

Vol 9 (3) ◽

pp. 221-224

Author(s):

Anuja V Bhalerao ◽

Richa Garg

Keyword(s):

Correct Diagnosis ◽

Management Strategies ◽

Androgen Insensitivity Syndrome ◽

Primary Amenorrhea ◽

Vaginal Septum ◽

Imperforate Hymen ◽

Secondary Sexual Characters ◽

Transverse Vaginal Septum ◽

Preservation Of Fertility ◽

Secondary Sexual

ABSTRACT Introduction Primary amenorrhea is a challenging entity as it affects the reproductive outcome. Primary amenorrhea is an absence of secondary sexual characters until 14 years of age or absence of menstruation with secondary sexual characters until 16 years of age. Aim The aim of this article is to study the frequency, etiologic causes, presentation, diagnosis, and optimal mode of management of primary amenorrhea. Materials and methods All girls who had not attained menarche until 16 years of age in the absence of secondary sexual characters and until 14 years, if no secondary sexual characters, and were willing for follow-up were subjected to investigations and were treated as per the etiology. Results Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome was the most common cause of primary amenorrhea (42.85%) followed by imperforate hymen (28.57%) and transverse vaginal septum (21.42%), one each of low, mid, and high varieties. There was one case of androgen insensitivity syndrome. Conclusion Establishing correct diagnosis is essential for planning treatment and management strategies in primary amenorrhea as treatment goals are preservation of fertility and progression of normal development. How to cite this article Bhalerao AV, Garg R. Müllerian Anomalies: A Cause for Primary Amenorrhea. J South Asian Feder Obst Gynae 2017;9(3):221-224.

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Congenital vaginal obstruction in young girls: need for standard post-operative dilatation protocol

International Surgery Journal ◽

10.18203/2349-2902.isj20185474 ◽

2018 ◽

Vol 6 (1) ◽

pp. 207

Author(s):

Philemon E. Okoro ◽

Sukarime S. Eli

Keyword(s):

Analytical Study ◽

Vaginal Septum ◽

Imperforate Hymen ◽

Young Girls ◽

Transverse Vaginal Septum ◽

Vaginal Tract ◽

Outcome Duration ◽

Age Range ◽

Active Can

Background: Congenital vaginal obstruction is a rare disorder in which there is blockage of the vaginal tract during the developmental stage and subsequently leading to accumulation of secretions and or menstrual blood. Surgical relief of obstruction is an effective treatment. Ensuring patency of the tract following surgery in young girls not sexually active can be challenging.Methods: This is a 10-years retrospective analytical study of cases of congenital vaginal obstruction in young girls seen in two centres from February 2007 to January 2017. Data retrieved from the case notes included age at presentation, presenting features, prior intervention, diagnosis, surgery performed, vaginal dilatations, outcome, duration of follow-up. Data was subjected to simple statistical analysis.Results: Eight patients met the inclusion criteria. The age range was 7 to 15years with a median of 12years. The cause of obstruction was transverse vaginal septum in 5 cases, imperforate hymen 2, vaginal hypoplasia 1. Three of the patients had no dilatation post operatively and of these, two came back with recurrent obstruction and hematometra. The third one was a case of imperforate hymen and did not develop stenosis despite not being dilated. There were no mortalities.Conclusions: The occurrence of recurrent obstruction following surgical treatment of congenital vaginal obstruction is high. Post-operative dilatation reduces incidence of recurrence.

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A Mesothelial Inclusion Cyst Presenting in a 40-Year-Old Woman as Abdominal Pain and Bloating – A Rare Diagnosis

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_001415 ◽

2020 ◽

Author(s):

Sonia Canadas ◽

Rita Fernandes ◽

Hugo Almeida ◽

João Santiago Correia

Keyword(s):

Abdominal Pain ◽

Abdominal Mass ◽

Tumour Marker ◽

Ca 125 ◽

Inclusion Cyst ◽

Microcytic Hypochromic Anaemia ◽

Hypochromic Anaemia ◽

History Of ◽

Cystic Abdominal Mass ◽

Work Up

Cystic mesotheliomas (also called mesothelial inclusion cysts) are rare benign neoplasms that occur more often in young women. Symptoms are usually non-specific, demanding a thorough work-up. We report a case of a 40-year-old female patient with 2 prior caesarean sections presenting with a 3-month history of abdominal pain. Laboratory tests revealed microcytic hypochromic anaemia and an elevated tumour marker CA-125. An investigation identified a large cystic abdominal mass, mostly in the left side of the abdomen. A laparotomy was performed with total resection of the lesion. Histological assessment resulted in a diagnosis of a mesothelial inclusion cyst. The patient had no recurrence after 3 years.

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An interesting rare case of spontaneous pregnancy with imperforate hymen and high transverse vaginal septum with bicornuate uterus

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20164692 ◽

2016 ◽

Vol 6 (1) ◽

pp. 341

Author(s):

Bharathi KR ◽

Vijayalakshmi S. ◽

Divya Alamelu N.

Keyword(s):

Reproductive Tract ◽

Genetic Mutation ◽

Interesting Case ◽

Female Reproductive Tract ◽

Vaginal Septum ◽

Imperforate Hymen ◽

Bicornuate Uterus ◽

Spontaneous Pregnancy ◽

Transverse Vaginal Septum ◽

Huge Impact

Congenital anatomic disorders of the female reproductive tract may result from genetic mutation, developmental arrest and abnormal hormonal exposure during embryonic development. These anomalies have a huge impact on the woman’s menstrual, sexual and reproductive functions. Pregnancy with these anatomic disorders is quite challenging. Here we present a rare interesting case of spontaneous pregnancy with multiple anatomic disorders namely- imperforate hymen, high transverse vaginal septum and bicornuate uterus.

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Primary Amenorrhoea with Transverse Vaginal Septum Presented with Infected Pyometra of 24 Weeks Size

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v12i1.18986 ◽

2018 ◽

Vol 12 (1) ◽

pp. 66-68

Author(s):

Rekha Paudel ◽

Ganesh Dangal ◽

Aruna Karki ◽

Hema Pradhan ◽

Ranjana Shrestha ◽

...

Keyword(s):

Abdominal Pain ◽

Abdominal Mass ◽

Lower Abdominal Pain ◽

Sex Characteristics ◽

Vaginal Septum ◽

Primary Amenorrhoea ◽

Tanner Staging ◽

Secondary Sex Characteristics ◽

Transverse Vaginal Septum ◽

Female Genital

Transverse vaginal septum is a congenital anomaly of the female genital outflow tract. It mostly remains unrecognized till adolescence and manifests as primary amenorrhoea with cyclic lower abdominal pain in background of appropriate Tanner staging secondary sex characterstics. Diagnosis is done by clinical examination and imaging, usually Magnetic Resonance Imaging. Early surgical management by vaginal or abdominal approaches improves the outcome. A 16 years, adolescent with appropriate Tanner staging secondary sex characteristics presented to gynecology (OPD) of Kathmandu Model Hospital with complaints of primary amenorrhoea and palpable abdominal mass of 24 weeks size with cyclic lower abdominal pain. Ultrasound showed features suggestive of hematometra. Under spinal anaesthesia, drainage and excision of the transverse vaginal septum was done followed by placement of vaginal mould post-operatively. We present here a case of primary amenorrhoea with pyometra secondary to transverse vaginal septum.

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A Case Report of Microperforate hymen presented with primary infertility

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i4.4897 ◽

2021 ◽

Vol 12 (4) ◽

pp. 2519-2522

Author(s):

Pavithra Baskaran ◽

Nidhi Sharma

Keyword(s):

Case Report ◽

Unique Case ◽

Vaginal Septum ◽

Imperforate Hymen ◽

Primary Infertility ◽

Main Complaint ◽

Transverse Vaginal Septum ◽

Paediatric Age ◽

Tract Infections

Micro perforate hymen is an uncommon congenital defect in which the hymen has a microscopic pinpoint aperture. It is a different entity from imperforate hymen, but it might present with more or less similar complaints. Here we are discussing about a unique case of pinpoint hymenal opening or microperforate hymen where the patient presented to us with primary infertility. Most cases of micro perforate hymen present in the paediatric age group with recurrent urinary tract infections and recurrent vulvovaginitis. Rare cases in a review of literature noted that a patient was seen to present with urethral dilatation during coital activity. In this case report, we present a patient who came with primary infertility who has never been examined in the past. She had regular menstrual cycles but scanty flow with the main complaint of dyspareunia. After examination, she was found to have microperforate hymen and suspected transverse vaginal septum defect. Hence, routine investigations were done, and we proceeded with hymenectomy. This example demonstrates the importance of a thorough genital examination and the inclusion of hymenal abnormalities in the differential diagnosis of women with recurrent dysuria, vaginitis, primary infertility, and oligomenorrhoea, so that early intervention can be done to improve the woman's quality of life and reduce pregnancy difficulties.

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