Uterus didelphys with cervical agenesis associated with adenomyosis, a leiomyoma and ovarian endometriosis. A case report.
BACKGROUND
Elevated level of serum CA-125 was detected in a 48-year-old woman who was diagnosed with a lateral fusion defect in association with congenital agenesis of the uterine cervix. This unusual case combined two developmental anomalies of the müllerian duct.


METHODS
A 48-year-old woman consulted our outpatient department due to persistent abdominal pain for six months. Bimanual pelvic examination showed absence of the cervix, an anteverted uterus and a 6-cm, left adnexal mass. Ultrasound and computed tomography revealed a uterus didelphys with a 3-cm cystic mass over the right ovary. Serum level of CA-125 was 641.4 U/mL. The patient underwent exploratory laparotomy, and total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Pathology confirmed adenomyosis and a leiomyoma of the uterus with functional endometrium in conjunction with endometriosis of the right ovary.


CONCLUSIONS
Multiple müllerian anomalies associated with adenomyosis and endometriosis should be considered in patients presenting with primary amenorrhea. Thorough evaluation, careful planning, fertility preservation and postoperative outcomes should be reviewed.
Yang
Chih-Chun
CC
Departments of Obstetrics and Gynecology and of Medical Research, Cardinal Tien Hospital-Hsintien, 362 Chung Cheng Road, Hsintien, Taipei County, 23137 Taiwan, R.O.C. ato5566@ms42.hinet.net
Tseng
Jen-Yu
JY
Chen
Pu
P
Wang
Peng-Hui
PH
D015746:Abdominal Pain / Q000209:etiology; D018394:CA-125 Antigen / Q000097:blood; D002584:Cervix Uteri / Q000002:abnormalities; D003937:Diagnosis, Differential; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009095:Mullerian Ducts / Q000002:abnormalities; D010049:Ovarian Diseases / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy; D014594:Uterine Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014599:Uterus / Q000002:abnormalities*
D018394:CA-125 Antigen