Rare case of fibroid degeneration involving nonfunctional, noncommunicating horn in woman with unicornuate uterus reported
Authors Luca Giannella, Leonardo Natalini, and Andrea
Ciavattini have reported a rare, misleading fibroid degeneration involving a
nonfunctional, noncommunicating horn in a woman with a unicornuate uterus.
Although the presence of a functional rudimentary horn may lead to signs and
symptoms that recommend its removal, nonfunctional cases are rarely reported,
and because of their apparent functional inactivity, the need for their removal
has not yet been reported. No previous report showed the possibility of a
degenerative process in a nonfunctional rudimentary horn causing patient
discomfort.
Setting included the University academic hospital. A
48-year-old White nulliparous premenopausal woman was referred to the
institution because of abdominal pain and an enlarging adnexal mass. Her
personal history showed primary infertility with a previous diagnosis of
unicornuate uterus. Given the possibility of ectopic ureters in these
occurrences, complete computed tomography was performed, and no genitourinary
alterations were found. Preoperative imaging (ultrasound evaluation, computed
tomography, and magnetic resonance imaging) provided a provisional diagnosis of
a suspicious ovarian fibroma.
Considering the patient’s age, lack of desire for pregnancy,
and volumetric increase in the adnexal mass, a laparoscopic intervention to
perform mass removal and prophylactic bilateral salpingectomy was planned. The
patient was counseled about the low risk of an underlying malignant
transformation. Therefore, the decision to remove the intact mass via a
minilaparotomy at the end of the surgery was shared. Once the abdominal cavity
was entered, the right unicornuate uterus was found in anatomical continuity
with the ipsilateral broad ligament, fallopian tube, and ovary. These
structures were wholly attached to the right pelvic wall. On the other side,
cranially compared with the right hemiuterus, a roundish myoma-like mass was
detected in direct connection with the left broad ligament, fallopian tube, and
ovary. In light of a changed intraoperative finding, amputation of the left
rudimentary horn and prophylactic bilateral salpingectomy were performed.
Laparoscopic removal of the uterine horn was successful, and
no intraoperative and postoperative complications occurred. The patient was in
good health at the 6-month follow-up visit. The histopathological examination
confirmed the fibroid degeneration and absence of the endometrium
The lack of symptomatic cases of rudimentary nonfunctional
horns reported in the literature led gynecologists to consider them a silent
Mullerian anomaly. This unique case demonstrates that even nonfunctional
rudimentary horns can undergo symptomatic transformation processes requiring
surgery. This information may be helpful for more comprehensive counseling of
women and for considering the possibility of this occurrence in the diagnostic
workup of misleading Mullerian anomalies. With this in mind, surgical treatment
can also be better planned as the technical aspects change compared with what
is expected for an adnexal pathology.
Source: Luca Giannella, Leonardo Natalini, and Andrea
Ciavattini; Fertil Steril® Vol. 122, No. 5, November 2024
