Cystic uterus masculinus
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Cystic Uterus Masculinus. The Duderus. Steps to Becoming a Real Boy. Testosterone Leydig cells Maintenance of Wolffian ducts Ductus deferans & epididymis 5 α -reductase converts testosterone to dihydrotestosterone Formation of the prostate and external genitalia.

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Cystic Uterus Masculinus

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Cystic uterus masculinus

Cystic Uterus Masculinus

The Duderus.

Jaime Rechy, DVM


Steps to becoming a real boy

Steps to Becoming a Real Boy

  • Testosterone

    • Leydig cells

    • Maintenance of Wolffian ducts

      • Ductusdeferans & epididymis

    • 5α-reductase converts testosterone to dihydrotestosterone

      • Formation of the prostate and external genitalia

Vegter, et. al., "Persistent Mullerian Duct Syndrome in a Miniature Schnauzer Dog with Signs of Feminization and a Sertoli Cell Tumour.“

Disney.wikia.com

Poth, T., W. Breuer, B. Walter, W. Hecht, and W. Hermanns. "Disorders of Sex Development in the Dog—Adoption of a New Nomenclature and Reclassification of Reported Cases." Animal Reproduction Science 121.3-4 (2010): 197-207. Print.


Steps to becoming a real boy1

Steps to Becoming a Real Boy

  • Anti-Müllerian hormone (AMH)

    • Sertoli cells

    • Regression of Müllerian structures (uterine horns, uterus, cervix, portion of vagina)

    • Critical ambisexual stage of reproductive tract differentiation

Meyers-Wallen, "Mullerian Inhibiting Substance Is Present in Embryonic Testes of Dogs with Persistent Mullerian Duct Syndrome”

Gray, et. al., Gray's Anatomy. Edinburgh: C. Livingstone, 1989.

Poth, T., et. al., "Disorders of Sex Development in the Dog—Adoption of a New Nomenclature and Reclassification of Reported Cases." Animal Reproduction Science 121.3-4 (2010): 197-207. Print.


The uterus masculinus

The Uterus Masculinus

  • Persistent Müllerian Duct Syndrome (PMDS)

    • Form of inherited male pseudohermaphroditism

    • Masculinized XY male

    • Uterus and uterine horns

  • PMDS in humans

    • Autosomal-recessive trait

    • Miniature Schnauzer

Vegter, et. al., "Persistent Mullerian Duct Syndrome in a Miniature Schnauzer Dog with Signs of Feminization and a Sertoli Cell Tumour.“

Atilola, et. al., “Cystic Uterus Masculinus in the Dog. Six Case History Reports."


Pmds of mice and men

PMDS: Of Mice and Men

  • Mutation in the AMH producing gene

  • Insensitivity of target organs

    • Mutation in AMH receptor gene

    • Canines

      *Absence of AMH action results in differentiation of Müllerian ducts

www.gleuclassbooks.com

Vegter, et. al., "Persistent Mullerian Duct Syndrome in a Miniature Schnauzer Dog with Signs of Feminization and a Sertoli Cell Tumour.“


Rusty rowdy

Rusty Rowdy

  • CC: “Recurrent cystitis”

  • rDVM Hx: “For about 2 months has been urinating in his sleep and urinates on owners when picked up”


Rusty rowdy1

Rusty Rowdy

  • PE: bright, alert, and rowdy

    • Urogenital

      • Micropenis and testicular hypoplasia

      • Small UB, urethra and prostate WNL on rectal

      • Neurologically normal; no spinal/LS pain

      • Dribbled “urine” when picked up

    • Reducible umbilical hernia

    • Remainder of PE WNL


Diagnostic imaging

Diagnostic Imaging


Radiographic conclusions

Radiographic Conclusions

  • “Possible causes for the ovoid soft tissue mass adjacent to the urinary bladder include cystic uterus masculinus, paraprostatic cyst, or ureterocele.”


Cystic uterus masculinus

SAG


Cystic uterus masculinus

TRANS


Sonographic conclusions

Sonographic Conclusions

  • “Bi-cornuate fluid-filled thick-walled structure caudal and dorsal to the neck of the urinary bladder and connecting to the prostate is most consistent with cystic uterus masculinus which is a rare congenital defect associated with fused Müllerian ducts.”


Cystic uterus masculinus

Pre-contrast

Post-contrast


Ct conclusions

CT Conclusions

  • “Irregular, fluid-filled structure is consistent with cystic uterus masculinus. No evidence of ectopic ureter.”


Cystic uterus masculinus

  • 6 dogs (Doberman, Golden, GSD, GSD X, Collie x 2); 4-11 years old

  • CS: Dysuria and constipation most common

  • Serosanguineous fluid inside

  • Bi-horned, cystic viscus; columnar epithelium

Atilola, Matthew A. O., and Paul W. Pennock. "CYSTIC UTERUS MASCULINUS IN THE DOG. Six Case History Reports." Veterinary Radiology Ultrasound 27.1 (1986): 8-14. Web.


Cystic uterus masculinus

  • Sig: 10 month old neutered male cat

  • CS: Intermittent fever, lethargy, stranguria

  • PE: Purulent discharge below rectum

  • Sx: Bicornuate cystic structure terminated caudally into urethra

  • Klebsiella pyometra

Schulman, Joanne. "Pyometra Involving Uterus Masculinus in a Cat." JAVMA 16.1 (2006): 50-53. Web.


Cystic uterus masculinus

Schulman, Joanne. "Pyometra Involving Uterus Masculinus in a Cat." JAVMA 16.1 (2006): 50-53. Web.


Cystic uterus masculinus

  • Sig: 6 year old neutered male cat

  • CC: Urethral obstruction

  • PE: Unable to acquire urine after catheterization

  • Dx: Catheter accidentally passed into UM

Sfiligoi, Gabriella, Kenneth J. Drobatz, and H. Mark Saunders. "Uterus Masculinus: An Unusual Complication in a Case of Feline Urethral Obstruction." Journal of Veterinary Emergency and Critical Care 0.0 (2005): n. pag. Web.


Treatment for um

Treatment for UM

UB = uterine body

B = urinary bladder

  • In humans, surgical excision is the definitive treatment of symptomatic Müllerian duct remnants

  • Surgery has been successful in veterinary patients

Krstic, Zoran D. "Surgical Treatment of the Mullerian Duct Remnants." Journal of Pediatric Surgery 36 (2001): 870-76. Web.

Atilola, Matthew A. O., and Paul W. Pennock. "CYSTIC UTERUS MASCULINUS IN THE DOG. Six Case History Reports." Veterinary Radiology Ultrasound 27.1 (1986): 8-14. Web.


Summary

Summary

  • Uterus masculinusis seen in the abnormal male as fused remnants of the Müllerian ducts

  • Form of male pseudohermaphroditism

  • “Zebra” for ddx in diagnostic imaging

    • Sig: male, dog/cat, +/- cryptorchid

    • Hx: UTI, dysuria, constipation, pyometra, prostatitis


References

References

  • Vegter, Ar, Hs Kooistra, Fj Van Sluijs, Lwl Van Bruggen, J. Ijzer, C. Zijlstra, and Ac Okkens. "Persistent Mullerian Duct Syndrome in a Miniature Schnauzer Dog with Signs of Feminization and a Sertoli Cell Tumour." Reproduction in Domestic Animals (2008): n. pag. Web.

  • Meyers-Wallen, V. N. "Mullerian Inhibiting Substance Is Present in Embryonic Testes of Dogs with Persistent Mullerian Duct Syndrome." Biology of Reproduction 48.6 (1993): 1410-418. Web.

  • Atilola, Matthew A. O., and Paul W. Pennock. "CYSTIC UTERUS MASCULINUS IN THE DOG. Six Case History Reports." Veterinary Radiology Ultrasound 27.1 (1986): 8-14. Web.

  • Adin CA, Proc. 8th Annual Dog Owners & Breeders Symposium. 2004.

  • Schulman, Joanne. "Pyometra Involving Uterus Masculinus in a Cat." JAVMA 16.1 (2006): 50-53. Web.

  • Sfiligoi, Gabriella, Kenneth J. Drobatz, and H. Mark Saunders. "Uterus Masculinus: An Unusual Complication in a Case of Feline Urethral Obstruction." Journal of Veterinary Emergency and Critical Care 0.0 (2005): n. pag. Web.

  • Meyers-Wallen, V. N. "The Critical Period for Mullerian Duct Regression in the Dog Embryo." Biology of Reproduction 45.4 (1991): 626-33. Web.

  • Krstic, Zoran D. "Surgical Treatment of the Mullerian Duct Remnants." Journal of Pediatric Surgery 36 (2001): 870-76. Web.

  • Poth, T., W. Breuer, B. Walter, W. Hecht, and W. Hermanns. "Disorders of Sex Development in the Dog—Adoption of a New Nomenclature and Reclassification of Reported Cases." Animal Reproduction Science 121.3-4 (2010): 197-207. Print.


Cystic uterus masculinus

9/12/2013, 12:06 PM, CT ABDOMEN

Medical Record: 243715

Patient Name: Rusty Rowdy

Client Name: Palmer

CT FINDINGS

A transverse multidetector helical data set was acquired from T10-T11 to the proximal tibiae and reconstructed at 2 mm and 4 mm slice thickness, using a soft tissue algorithm. Additional datasets were acquired immediately, 3 minutes post-administration, and 5 minutes post-administration of contrast medium and similarly reconstructed.

The urinary bladder is minimally distended and slightly displaced toward the left. Immediately dorsal to the urinary bladder, in the region of the trigone, there is an irregularly marginated, fluid-filled structure with peripheral contrast enhancement. The fluid filled lumen of this structure is also irregularly marginated and does not appear to communicate with the urinary bladder. This structure continues caudally to the level of the prostate. The insertion of the ureters is normal. Two tubular structures extend from the region of the trigone through the inguinal rings to connect to ovoid structures lying on either side of the prepuce in the inguinal area.

The medial iliac and jejunal lymph nodes are at the upper limits of normal size. The stomach is distended with fluid and a moderate amount of kibble-like ingesta. The remaining abdominal structures are normal.

CONCLUSIONS

An irregular, fluid-filled structure dorsal to the trigone the prostate is consistent with a cystic uterus vasculitis. Bilateral cryptorchidism. Gastric distension warrants caution during anesthetic recovery.

ELF


Cystic uterus masculinus

9/11/2013, 11:27 AM, ABDOMEN

Medical Record: 243715

Patient Name: Rusty Rowdy

Client Name: Palmer

RADIOGRAPHIC FINDINGS

Right lateral and ventrodorsal views of the abdomen are available. The liver and spleen are normal. The kidneys are normal in size and smoothly marginated. In the caudal abdomen, there are 2 ovoid soft tissue opacities. One of these, likely the more cranial, is the urinary bladder. The other is of uncertain origin. There is a moderate volume of gas in the stomach. The stomach and intestinal tract are otherwise normal. There is mildly decreased serosal detail in the mid abdomen, likely due to decreased intra-abdominal fat. On the ventral abdomen within the subcutaneous tissues, there is a broad-based fat and soft tissue opacity nodule.

CONCLUSIONS

Possible causes for the ovoid soft tissue mass adjacent to the urinary bladder include cystic uterus masculinus, paraprostatic cyst, or ureterocele. Abdominal ultrasound is recommended for further assessment.

Probable umbilical hernia. This structure may also be examined using ultrasound.

ELF


Cystic uterus masculinus

Medical Record: 243715

Exam Date: 09/11/13

Animal’s Name: Rusty

Owner’s Name: Palmer

----- Sonographic Findings: -----

----- ABDOMEN -----

Peritoneal cavity: Normal cavity.

Abdominal wall: An umbilical hernia is observed with only peritoneal fat observed in the hernial sac which can be reduced. A small defect in the wall measuring approximately 4.3 mm is observable at the umbilicus.

Liver: Normal

Gall bladder: Normal

Spleen: Normal

Kidneys:

Left: Decreased corticomedullary distinction is observed with slight pyelectasis measuring approximately 1.5 mm. No evidence of renal mineralization or calculi are observed.

Right: Decreased corticomedullary distinction is observed with slight pyelectasis measuring approximately 1.5 mm. No evidence of renal mineralization or calculi are observed.

Urinary bladder: The bladder is moderately distended with fluid containing suspended echogenic debris that is freely movable. The urinary bladder wall is normal. A thickwalledbicornuate fluid-filled structure is observed dorsal to the neck of the bladder continuing to and connecting with the prostate. The structure measures approximately 3.9 cm in length and 3.4 cm width with the 2 fluid-filled side-by-side structures in the cranial aspect measuring approximately 1.3 cm and 1.4 cm in diameter.

Adrenal glands:

Left: Normal measuring 3.6 mm in transverse diameter.

Right: Normal measuring 4.1 mm in transverse diameter.

Lymph nodes:

Left medial iliac: Mildly enlarged measuring 0.61 cm in diameter.

Right medial iliac: Normal

Mesenteric: Normal


Cystic uterus masculinus

GI:

Stomach: Normal

Duodenum: Normal

Jejunum: Normal

Colon: Normal

Pancreas: Normal

Genital:

Ovaries:

Uterus:

Prostate:

Testicle: The right testicle measures approximately 5.65 mm in diameter. The left testicle is slightly smaller measuring 5.1 mm and diameter. The parenchyma of the testicles is normal.

----- Sonographic Conclusions: -----

Bicornuate fluid-filled thickwalled structure dorsal to the neck of the urinary bladder and connecting to the prostate is most consistent with uterus masculinus which is a rare congenital defect associated with fused müllerian ducts.

Bilateral renal changes and echogenic urine compatible with chronic renal disease and possible pyelonephritis/cystitis. These findings should be correlated with serum chemistries and urinalysis.

Mild enlargement of the left medial iliac lymph node likely reactive lymphadenopathy associated with either urinary tract infection or associated with the uterus masculinus

Reducible umbilical hernia containing only peritoneal fat.

Multiple attempts at sonographically guided fine needle aspiration of the fluid of the suspected uterus masculinus were unsuccessful in obtaining fluid.

George A. Henry, DVM, Diplomate ACVR


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