Literature DB >> 27857474

Embryogenesis of vagina and embryopathogenesis of Herlyn-Werner-Wunderlich syndrome.

Yashant Aswani1.   

Abstract

Entities:  

Year:  2016        PMID: 27857474      PMCID: PMC5036346          DOI: 10.4103/0971-3026.190411

Source DB:  PubMed          Journal:  Indian J Radiol Imaging        ISSN: 0970-2016


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Sir, I read with great interest the article titled, “Herlyn–Werner–Wunderlich syndrome presenting with infertility: Role of MRI in diagnosis” by Ahmad et al. published in the Indian Journal of Radiology and Imaging.[1] The manuscript is excellent and informative. However, I would like to make the following contribution. Herlyn–Werner–Wunderlich syndrome comprises of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis/anomaly. Hence, the acronym OHVIRA syndrome.[1] The embryopathogenesis of OHVIRA syndrome is debatable. While the classical theory puts forth Mullerian (paramesonephric) roots of upper vagina, Acien's hypothesis postulates mesonephric (Wolfian) origin of vagina in entirety except its lining epithelium from the Mullerian tubercle.[234] Common to both, the traditional and Acien's view is formation of the kidney and the uterus with cervix. The former develops as a result of inductive effect of metanephric blastema (derived from the Wolfian duct at 5 weeks of gestation) into metanephros; for the latter, the mesonephros allows for proper positioning and subsequent caudal fusion of paramesonephric ducts.[4] Wolfian birth of vagina, put forth by Acien (and supported by experiments of Sanchez on female rats),[34] explains OHVIRA as a faulty development of mesonephros that results in three-fold effects; (a) failure of formation of metanephric blastema from the Wolfian duct and hence subsequent renal agenesis/anomaly, (b) absence of supportive function and possibly growth factors from mesonephros halts the fusion of paramesonephric ducts (uterus didelphys), and (c) a blind hemivagina (postulated to be a derivative of mesonephros) on the same side.[234] Thus, this fully explains the cascade of events. To conclude, I once again commend the authors for an excellent article. However, in light of new research, a fresh perspective towards the embryogenesis of vagina needs to be adopted.

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  4 in total

Review 1.  Embryological observations on the female genital tract.

Authors:  P Acién
Journal:  Hum Reprod       Date:  1992-04       Impact factor: 6.918

2.  Experimental contributions to the study of the embryology of the vagina.

Authors:  M L Sánchez-Ferrer; M I Acién; F Sánchez del Campo; M J Mayol-Belda; P Acién
Journal:  Hum Reprod       Date:  2006-02-13       Impact factor: 6.918

3.  OHVIRA: Uterus didelphys, blind hemivagina and ipsilateral renal agenesis: Advantage MRI.

Authors:  Sunil K Bajaj; Ritu Misra; Brij B Thukral; Rohini Gupta
Journal:  J Hum Reprod Sci       Date:  2012-01

4.  Herlyn-Werner-Wunderlich syndrome presenting with infertility: Role of MRI in diagnosis.

Authors:  Zohra Ahmad; Ankur Goyal; Chandan J Das; Dipika Deka; Raju Sharma
Journal:  Indian J Radiol Imaging       Date:  2013-07
  4 in total

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