Ara and Abidin Brunei International Medical Journal 2025;21:102-105 Brunei International Medical Journal OHVIRA syndrome - A rare Müllerian abnormality Rahat ARA1* and Nuoorul ABIDIN1

Twin reversed arterial perfusion (TRAP) sequence is a rare, unique complication of monochorionic twin pregnancy in which one of the twins with an absent or a non-functioning heart (acardiac twin) is per- fused by its own co-twin (pump twin) via placental arterial anastomosis. The anomalous twin may ap- pear as a heterogenous mass simulating a teratoma or intrauterine foetal demise and has poorly devel- oped heart, upper body and head. The normal twin faces the excess burden of having to send and re- ceive blood from the acardiac mass as well as its own growing tissue and is at risk of heart failure and preterm birth. Left untreated, in up to 50% of cases, this otherwise normal twin may die in utero or shortly after birth. We report the case of a TRAP sequence in a monochorionic twin pregnancy. Unfortu- nately, the pump twin died because mother went into premature labour that was complicated by ab- ruptio placenta at 26 weeks of gestation.

Carcinoma of the vagina is uncommon and only constitutes two percent of malignant neoplasms of the female genital tract. Malignant melanoma of the vagina is rarer and accounts for only 3.2% of all vaginal cancers. It presumably arises from melanocytes found in the vagina of three percent of normal women. It is a very aggressive tumour and the overall prognosis is poor despite the treatment. We report the case of an 81-year-old woman who presented with per vagina bleeding secondary to a malignant melanoma of the vagina. She was treated with radiotherapy as her disease was locally extensive and she was not a candidate for pelvis exenteration. This is the first recorded case of malignant melanoma to be diagnosed in Brunei Darussalam.