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Gartner duct cyst

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on 26 December 2013

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Transcript of Gartner duct cyst

Gartner duct cyst
A gartner duct cyst develops from embryologic
Remnants of the wolffian (mesonephric) duct

it is located in anterolateral wall of the proximal (superior)3rd of the vagina2 and are typicallylocated above the level of the inferior most aspect of the pubic symphysis
In rare cases with larger cysts , the presence of
Dyspareunia and problems in obstetric delivery are described

Image by Tom Mooring
cogenital anomalies
of female genitalia

Clinical presentation

When they are located in the lower vagina at the
Level of the urethra , they can cause mass effect on the urethra
And give rise to urinary tract symptoms

Adenosis of the vaginal wall consists of islands of columnar epithelium in the normal squamous epithelium.it is often located in the upper third of the vagina. The incidence of this finding is much higher in women exposed in utero to diethylstibestrol. Dysontogenic cysts of the vagina are generally thick walled soft cysts resulting from embryonic remnants
Is most commonly found at the junction of the upper and middle thirds of vagina. At times, a transverse vaginal septum will have a sinus tract or small perforation that allows menstruation. Thus, the septum may become apparent only after intercourse is impeded. Patient wtith an imperforate hymen or transverse vaginal septum usually have normal development of the upper reproductive tract
Transverse vaginal septum
The arcuate uterus is a form of a uterine anomaly or variation where the uterine fundus displays a concave contour towards the uterine cavity. Normally the fundus of the uterus is straight or convex on anterior-posterior imaging but in the arcuate uterus it dips into the cavity and may form a small septation. The distinction between an arcuate uterus and a septate uterus is not standardized

Arcuate uterus
is an abnormal enlargement of the clitoris (not to be confused with the normal enlargement of the clitoris seen during sexual arousal) that is mostly congenital or acquired, though deliberately induced clitoris enlargement as a form of female genital body modification is achieved through various uses of anabolic steroids, including testosterone, and may also be referred to as clitoromegaly

Congenital abnormalities of vagina
Many variations and combinations of anomalies of vagina occur. The more common anomalies of the vagina include canalization defects such as : imperforate hymen, longitudinal and transverse vaginal septa, partial development (vaginal atresia), and double vagina. Congenital absence of the vagina (agenesis) is less common.

Definition of Imperforate hymen:

Represent the mildest form of these canalization abnormalities.
Position of imperforate hymen:
It a occurs at the site where the vaginal plate contacts the urogenital sinus.
After birth ,
a bulging , membrane- like structure may be noticed in the vestibule , usually blocking egress of mucus . If not detected until after menarche.

an imperforate hymen may be seen as a thin

, dark blush or thicker , clear membrane blocking menstrual flow at the introitus.

Imperforate hymen
Atresi of the vagina generally represents
a more substantial lack of canalization
at the caudal or cranial end of the vaginal plate .if cranially placed, the upper vagina and cervix may be absent, whereas the uterine fundus and fallopian tubes remain unaffected.
Vaginal Atresia is a birth defect or congenital abnormality of the female genitourinary system that manifests itself in the absence of a vagina (vaginal agenesis), or a deformed and nonfunctional vagina (Vaginal Atresia).

It is frequently associated with Mayer-Rokitansky-Küstner-Hauser (MRKH) syndrome, in which the most common result is an absent uterus in conjunction with a deformed or missing vagina, despite the presence of normal ovaries and normal external genitalia.

The situation is most urgent where the normal uterovaginal outflow is obstructed. In this case prompt medical action is required.

Vaginal atresia is estimated to occur in 1 in 4000–5000 live female births. It is often unnoticed until adolescence, when pain and a lack of menstrual flow indicates the condition.[1] When a doctor diagnoses Vaginal Atresia, there are numerous remedies based on the exact details of the condition. In some cases, surgery can repair the defect or a new vagina can be fabricated using an intestinal graft

Endometrial Polyps form from the endometrium to create abnormal protrusions of friable tissue into the endometrial cavity .
They can cause menorrhagia & spontaneous bleeding during the reproductive years & postmenopausal bleeding after menopause .
On ultrasound, endometrial polyps may appear as a focal thickening of the endometrial stripe . They can be more clearly recognized on saline infusion sonography or visualized directly by hysteroscopy .

Endometrial Polyps
Endometrial polyps may evade detec-tion by endometrial aspiration or dilation and curet-tage ,, because they are too large to be aspirated through the sampling orifice and are very flexible and can fold out of the path of the sharp curette .
Histologic evaluation of the polyp is imperative because although most are benign, endometrial hyperplasia, endometrial carcinoma, and carcinosarcomas may also present as polyps.

Asherman's syndrome
Asherman's syndrome (AS) or Fritsch syndrome, is a condition characterized by adhesions and/or fibrosis of the endometrium most often associated with dilation and curettage of the intrauterine cavity.

A number of other terms have been used to describe the condition and related conditions including: injurious intrauterine adhesions, uterine/cervical atresia, traumatic uterine atrophy, sclerotic endometrium, endometrial sclerosis, and intrauterine synechiae

This lining is composed of two layers, the functional layer (adjacent to the uterine cavity) which is shed during menstruation and an underlying basal layer (adjacent to the myometrium), which is necessary for regenerating the functional layer. Trauma to the basal layer, typically after a dilation and curettage (D&C) performed after a miscarriage, or delivery, or for medical abortion, can lead to the development of intrauterine scars resulting in adhesions that can obliterate the cavity to varying degrees. In the extreme, the whole cavity can be scarred and occluded. Even with relatively few scars, the endometrium may fail to respond to estrogen .

may result in infertility, repeated miscarriages and can also result from other pelvic surgeries including cesarean section

is a disorder that occurs in females and mainly affects the reproductive system. the uterus and the vaginal canal do not develop properly during the pregnancy and the female is born with a very short vaginal canal or no vagina at all .
Type I is characterized by an isolated absence of the proximal two thirds of the vagina
type II is marked by other malformations, including vertebral, cardiac, urologic (upper tract)

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome
Bicornuate Uterus
A bicornuate uterus is a uterus that has two horns and a heart shape. The uterus has a wall inside and a partial split outside. A bicornuate uterus is the most common congenital uterine anomaly and can impact a woman's reproductive capabilities.

Mullerian duct:
The lower 1/3 of both ducts didn’t fuse together & forms a two horns and a heart shape of uterus.

The condition is associated with an increased rate of spontaneous abortion, though the miscarriage rate is lower with a bicornuate uterus than with a septate uterus..
Diagnostic procedures:
Pelvic exam

Metroplasty surgerCervical cerclage
Inclusion cyst
swellingsthat sometimes develop on a womens vagina.Commonly ,these swellings are the result of fluid that has backed up in a clogged gland or ductThe cysts develop on the walls of inclusiom cysts also commonly referred to as vaginal cysts are minorthe vagina and may be very small and non-painful, but can grow to be very large and quite uncomfortable,especially if one becomes infected
These may occur during the birth of a baby or after surgery

The longitudinal septum may be only partially present at various levels in the upper and middle vagina .ether in the midline or deviated to one side. In addition, a longitudinal septum may attach to the lateral vagina wall , creating a blind vagina pouch, with or without a communicating sinus tract.

Midline longitudinal septum

These septa
are usually associated whit double cervix and one of the various duplication anomalies of the uterine funds , although the upper tract is often entirely normal

The midline longitudinal vagina septum
Is asymptomatic . it may be discovered by routine examination and can be visualized by holding the labia apart . sometimes the patient discovers it may palpation while inserting a vagina tampon and when tow tampons are required . The septum may be extend to the vagina vault with a uterus didelphys or may end before reaching the vault . if it disturbs the patient emotionally . surgery is appropriate
A unicornuate uterus represents a uterine malformation where the uterus is formed from one only of the paired Müllerian ducts while the other Mullerian duct does not develop or only in a rudimentary fashion. The sometimes called hemi-uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

Unicornuate uterus


The uterus is normally formed during embryogenesis by the fusion of the two Müllerian ducts. If one of the ducts does not develop, only one Müllerian duct contributes to the uterine development. This uterus may or may not be connected to Müllerian structure on the opposite site if the Müllerian duct on that site undergoes some development. A unicornuate uterus has a single cervix and vagina. Associated defects may affect the
renal system, and less common, the skeleton.

The uterus is formed during embryogenesis by the fusion of the two mullerian ducts. During this fusion a resorption process eliminates the partition between the two ducts to create a single cavity. This process begins caudally and advances cranially, thus an arcuate uterus represents an in the final stage incomplete absorption process.
A pelvic examination will not reveal the condition. Investigations are usually prompted on the basis of reproductive problems.

Helpful techniques to investigate the uterine structure are transvaginal ultrasonography and sonohysterography, hysterosalpingography,
MRI, and hysteroscopy. More recently 3-D ultrasonography has been advocated as an excellent non-invasive method to delineate the condition

Clitoromegaly is otherwise a rare condition and can be either present by birth or acquired later in life. If present at birth, congenital adrenal hyperplasia can be one of the causes, since in this condition the adrenal gland of the female fetus produces additional androgens and the newborn baby has ambiguous genitalia which are not clearly male or female. In pregnant women, who received norethisterone during pregnancy masculanization of fetus occurs, resulting in hypertrophy of clitoris;[10] although this is rarely seen nowadays due to use of safer progestogens. It can also be caused by the autosomal recessive congenital disorder known as Fraser syndrome
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