Herlyn-Werner-Wunderlich syndrome, characterized by uterus didelphys with blind hemivagina and ipsilateral renal agenesis, is a rare Mullerian duct anomaly. This case series shows a wide spectrum of the condition, one presenting in an adolescent, managed conservatively and the other in the perimenopausal age group given a more definitive management. The first case is an 18-year- old nulligravid who manifested with progressive dysmenorrhea and foul smelling vaginal discharge a few years after menarche. She subsequently underwent vaginal septotomy followed by diagnostic hysteroscopy. On the other hand, the second case is a 46- year-old nulligravid whose chief complaint is a foul smelling vaginal discharge and consequently went through a total abdominal hysterectomy with salpingo-oophorectomy. To our knowledge, the second case is the only patient diagnosed in the perimenopausal stage and underwent a total hysterectomy. Ultrasound is the first-line imaging modality used in both cases and its merits are highlighted to prove its importance and diagnostic value in the workup of this condition.
Mullerian aplasia ; Mullerian Ducts ; Urogenital Abnormalities

OBJECTIVE: To determine if salivary ferning correlates significantly with sonographic indices in identifying the fertile period, and whether it may be used as a cheaper, and more convenient way to aid infertility patients in achieving pregnancy.

POPULATION: Subjects who complain of difficulty achieving pregnancy and for whom follicle monitoring was indicated were recruited from the Outpatient Department in a tertiary hospital in Manila.

METHODOLOGY: Patients (n=40) with Primary or Secondary Infertility from April 2013 to August 2015 who require serial follicle monitoring as part of infertility work up were recruited in the study. For every follicle monitoring by ultrasound done by one sonologist, a salivary sample was obtained from the subject and the ferning pattern was determined and recorded by one pathologist blinded as to the day of the subject's menstrual cycle.

RESULTS: There was a total of 40 subjects who underwent 2 serial follicle monitoring during the study. The 1 st TVS (preovulatory) was done between Day 9 to 14 of the cycle with an average of Day 11. Correspondingly, salivary ferning done showed that there were 26 (65.0%) with Salivary Ferning 1 pattern and 14 (35.0%) with Salivary Ferning 2 pattern (p=0.35). This showed no significant difference between follicle monitoring and salivary ferning pattern and either may be used in identifying fertile period preovulatory. The 2nd TVS (postovulatory) was done between Day 12 to 21 with an average of Day 16. All the second ultrasound findings showed signs of ovulation. Correspondingly, there were 1 (2.0%) showed Salivary Ferning 1 pattern, 11 (27.5%) showed Salivary Ferning 2 Pattern and 28 (70.0%) showed Salivary Ferning 3 Pattern 9 (p=0.05). This showed no significant difference between follicle monitoring and salivary ferning pattern, hence, TVS follicle monitoring remains more reliable in identifying that ovulation has occurred.

CONCLUSION: Salivary ferning corresponded well with ultrasonographic findings during the preovulatory phase of the cycle, while no correlation was noted between the salivary ferning pattern and the postovulatory phase of the cycle. Hence, sonographic follicle monitoring remains a better predictor of ovulation, and more effective in identifying the fertile period

Human ; Female ; Adult ; Pregnancy ; Follicular Phase ; Luteal Phase ; Fertile Period ; Tertiary Care Centers ; Outpatients ; Pathologists ; Ovulation ; Ovarian Follicle ; Infertility

OBJECTIVE: To compare the diagnostic performance of Power Doppler versus Saline Infusion Sonography (SIS) in the diagnosis of endometrial polyps in patients who present with abnormal uterine bleeding using histopathological confirmation.

METHODS: This is a 2-year cohort study involving non-pregnant patients with abnormal uterine bleeding examined prospectively and subjected to both transvaginal sonography with power Doppler and SIS. Single-vessel pattern/comma-like patterns on power Doppler were considered positive. Results were compared to the gold standard histopathological examination obtained by endometrial biopsy, curettage, or hysteroscopic resection of endometrial polyp.

RESULTS: A total of 42 patients completed the study and were included in the final analysis. Thirty-five (35) patients had confirmed endometrial polyp by histopathology. Power Doppler was positive in 32 of these patients. SIS, on the other hand was positive in 16 patients. The results are as follows: sensitivity 89%, specificity 83%, and positive and negative predictive values 97% and 56% respectively for power Doppler. For SIS, on the other hand, sensitivity 46%, specificity 86%, positive and negative predictive values of 94% and 24% respectively.

CONCLUSION: Power Doppler is as useful in identifying patients with endometrial polyps and can be used in place of the traditional test SIS. Its diagnostic accuracy is better than SIS.

 

Human ; Male ; Female ; Middle Aged ; Adult ; Uterine Neoplasms ; Polyps ; Ultrasonography ; Sensitivity And Specificity ; Uterine Hemorrhage ; Curettage ; Biopsy

The goal of this study was to determine the ovarian reserve by sonographic measurement of ovarian volume and antral follicle count, then correlate with menstrual pattern in women belonging reproductive age. All patients were grouped accordingly into early, mid and late reproductive age group. Transvaginal or transrectal sonography was performed on the follicular phase of the menstrual cycle. Ovarian volumes and antral follicle counts of both ovaries were determined sonographically and recorded.

METHODS: A total of 160 subjects were included in the study. Infrequent; menstrual pattern were noted in half (50%) of the subjects. Irregular menstrual pattern were noted in more than half (55%) of the subjects. Almost 60% were noted to have shortened duration of menstrual pattern. There were 92 (57.5%) with light menstrual pattern.

RESULTS: Results showed ovarian volume and antral follicle count decreases with increasing age. Ovarian volume of subjects with infrequent menstrual pattern was significantly higher than those with frequent menstrual pattern but is significantly higher than those with normal menstrual pattern. Ovarian volume of subjects with irregular menstrual pattern were significantly higher than those with regular menstrual pattern. Antral follicle count of subjects with infrequent menstrual pattern was significantly higher than those with frequent menstrual pattern but is significantly higher than those with normal menstrual pattern. Antral follicle count of subjects with irregular menstrual pattern were significantly higher than those with regular menstrual pattern. Results showed that there was a significant difference both in the ovarian volume and antral follicle count according to age as well as frequency and regularity of menstrual pattern.

Human ; Female ; Adolescent ; Child ; Menstruation ; Menarche ; Ovary ; Ultrasonography ; diagnostic imaging

The objective of this paper was to evaluate if the presence of normal ovarian tissue adjacent to an adnexal mass - "ovarian crescent sign" can foretell the benignity of its nature and to prove its validity as an effective sonographic marker for the exclusion of ovarian malignancy. Study design employed was longitudinal observational prospective cohort study involving 68 women diagnosed with adnexal tumor. Demographic data as well as symptomatology were noted. All patients underwent pelvic grayscale sonogram whether ovarian crescent sign was present or absent. Histopathological examination report obtained after surgery was considered the gold standard. Out of 68 subjects, 18 were positive for malignancy. Ovarian Crescent Sign is a useful sonographic feature which can be used in excluding invasive nature of adnexal masses.

Ovarian Crescent Sign ; Ultrasonography ; Andnexal Mass ; Ovarian Cancer

Virilizing tumors during pregnancy are extremely rare. This case of a 33 year old, gravid 3 para 2, presented with hirsutism and clitoromegaly at 5 months age of gestation. Her past medical and menstrual histories were non-contributory. Ultrasound done during her prenatal check-up at 34 weeks age of gestation revealed an ovarian new growth on the left ovary features suggestive of a benign nature. On her 38th week of pregnancy, LTCS III with right tubal ligation and left salpingooophorectomy were performed and a baby boy weighing 3000 grams without any gross abnormalities was delivered. Histopathologically, the tumor proved to be a benign mucinous cystadenoma. This paper presented an ovarian mucinous cystadenoma with virilizing features that are transient and reversible. Therefore, an ovarian neoplasm should always be considered as a differential diagnosis for causes of virilization during pregnancy.
Human ; Female ; Adult ; HIRSUTISM ; PREGNANCY ; CYSTADENOMA, MUCINOUS

Virilizing tumors during pregnancy are extremely rare. This case of a 33 year old, gravid 3 para 2, presented with hirsutism and clitoromegaly at 5 months age of gestation. Her past medical and menstrual histories were non-contributory. Ultrasound done during her prenatal check-up at 34 weeks age of gestation revealed an ovarian new growth on the left ovary features suggestive of a benign nature. On her 38th week of pregnancy, LTCS III with right tubal ligation and left salpingooophorectomy were performed and a baby boy weighing 3000 grams without any gross abnormalities was delivered. Histopathologically, the tumor proved to be a benign mucinous cystadenoma. This paper presented an ovarian mucinous cystadenoma with virilizing features that are transient and reversible. Therefore, an ovarian neoplasm should always be considered as a differential diagnosis for causes of virilization during pregnancy.
Human ; Female ; Adult ; Hirsutism ; Pregnancy ; Cystadenoma, Mucinous

Introduction: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women, present in 5-10 percent of women of reproductive age group with reported increased risk of developing adverse cardiovascular disease, dyslipidemia, hyperinsulinemia, hyperandrogenemia and early onset of type 2 diabetes mellitus. Objective: The purpose of this study was to evaluate and compare the effects of metformin with exercise and diet modification versus exercise and diet modification alone on BMI, Ferriman-Gallwey Score (FGS), ovarian volume, and menstrual cycle length. Methodology: Fifty-two Filipino women with PCOS participated in this prospective, randomized, open-labeled study. The subjects were then randomized to control group (n=26) given exercise and diet modification and metformin group (n=26) given metformin 500mg TID with exercise and diet modification for the period of 6 months. BMI, FGS, ovarian volume and menstrual cycle length were taken for both groups and these were reevaluated after 6 months. Likewise, all subjects were screened for glucose intolerance using 75 g OGTT. Results: The mean age and BMI of all subjects with PCOS (n=52) were 25.51 +/- 0.49 years and 24.48 +/- 0.61 kg/m2 respectively. The metformin group showed no significant reduction in BMI and ovarian volume. However, there was a significant reduction in BMI (P= 0.010) and ovarian volume (R P= 0.002, L P= 0.047) when the metformin group was compared to the control group but not in the FGS. A higher percentage of eumenorrheic subjects were noted in the metformin group compared with the control group (46 percent vs 27 percent). No significant increase in the incidence of impaired glucose intolerance was noted. Conclusion: Metformin has a beneficial effect in patients with PCOS in reducing BMI, ovarian volume, and improving menstrual regularity. However, no significant change was noted in the FGS. (Author)
Metformin ; Policystic Ovary Syndrome ; Oral Glucose Tolerance Test ; Menstrual Cycle ; Body Mass Index