Gartner's duct cyst is a relatively common benign cystic lesion and represents embryologic remnants of Wolffian ducts. These cysts are usually small and asymptomatic and have been reported to occur in as many as 1% of all women. We report a case of a 30 month old baby presenting with recurrent urinary tract infection and Gartner's duct cyst communicating with the vagina and bladder with associated complete vaginal diaphragm. The diagnosis of Gartner's duct cyst was suggested by pelvic ultrasonography and MR imaging. Vaginal diaphragm and communication between the Gartner's cyst, the bladder and vagina were established during cystoscopy and vaginoscopy.

A brief review of the technique of hysterosalpingography is provided. It remains an important diagnostic study in searching for causes of infertility. HSG is a safe, simple procedure that enables the lumina of the uterine cavity and fallopian tubes to be outlined. Fundamentals in techniques have been stressed so as to limit the errors of omission and commission. During the course of many years, I have been honored by my colleagues, who have requested me to review interesting HSGs. Thus, I have been able to accumulate a series of x-rays that I can share with the readers of Modern Trends. Although these photographs seemed unique, many of them probably have been seen by other investigators. They are presented because of their important diagnostic features.

Our present understanding of the sequence and mechanisms of human genital organogenesis is reviewed. Current theories about the derivation of the vaginal epithelium are examined and tested against two anomalous circumstances, congenital androgen insensitivity and agenesis of the lower vagina, which are presented as examples demonstrating the respective participation of the urogenital sinus or of the Müllerian ducts alone in the developmental process. The abnormalities recently described in the vagina and cervix of girls exposed in utero to diethylstilbestrol (DES) correspond remarkably with those encountered in lower vaginal agenesis, particularly with regard to the presence of vaginal adenosis, the deficiency of glycogen in the squamous cells (squamous metaplasia), and the abnormal response of the squamous epithelium to Schiller's iodine test. It is concluded that the development of the human vagina is best explained by the theory which holds that the Müllerian ducts in fetal life extend caudally to the level of the future hymen. After fusion of these ducts, squamous cells arising in the epithelium of the urogenital sinus invade from below, advance, and replace completely the Müllerian mucosa up to the level of the external os of the cervical canal.

The urinary and genital systems are closely related in their development so that dividing them into separate divisions is often artificial. The lower urinary system begins as a cloaca. The urorectal septum then divides the cloaca into a ventral urogenital sinus and a dorsal hindgut. The ureteral bud forms off the mesonephric duct. The male and female genital systems are the same until the gonad assumes characteristics of the testis or ovary in the eighth week of gestation. It is not until the eleventh or twelfth week that the external genitalia assume specific sexual characteristics. Anomalies of the urethra and bladder can vary from a severe epispadias-exstrophy complex to a minimal Type I urethral valve. Ureteral anomalies include duplications, ectopia, and ureteroceles. An undescended testis is probably the most common anomaly in the male genital tract. Female genital anomalies can include a variety of uterine duplication anomalies. Gonadal abnormalities are often created by a chromosomal defect and are ultimately reflected by abnormal sexual differentiation.

Previous studies from this laboratory indicated a role for epidermal growth factor (EGF) in androgen-dependent male sexual differentiation. The mechanism by which EGF modulates male sexual differentiation has not been determined and investigation has been made to assess the role for androgen receptor (AR) in mediating the EGF-induced effect. We report that EGF, like androgen, stabilized the Wolffian duct in the 13-day female specimen, grown in organ culture. Anti-AR, flutamide and cyproterone acetate blocked the Wolffian duct-stabilizing effect of EGF. EGF also induced cell proliferation of the fetal reproductive tract in a dose-dependent manner and a combination of physiological dosages of EGF and androgen-induced cell proliferation synergistically, suggesting an interactive effect of these two drugs. Cyproterone acetate blocked both EGF-induced normal cell proliferation and the synergistic cell proliferation induced by combination of EGF and androgen suggesting a role of AR in the effects of EGF. The role of AR was further assessed by determining the effect of EGF on AR binding directly. It was shown that EGF stimulated androgen binding activity of the male fetal reproductive tract cells significantly by increasing the number of binding sites by 3-fold with slight decrease in binding affinity. Thus, it appears that AR plays a role in mediating EGF-modulation of sexual differentiation.

PURPOSE: Sexual differentiation in gonadal dysgenesis is commonly asymmetrical. In patients with true hermaphroditism there may be an ovary and müllerian duct on 1 side, and a testis and wolffian duct on the other side. Such asymmetry suggests that testicular hormones only act locally at this early stage of sexual differentiation. We tested the hypothesis that testosterone reaches the wolffian duct by transport down the duct rather than by simple diffusion. MATERIALS AND METHODS: Mouse 14-day urogenital ridges were placed in organ culture and microinjected with testosterone-albumin-fluorescein isothiocyanate. RESULTS: At 17 hours fluorescence was found throughout the wolffian duct and by 48 hours it was maximal in the dilated caudal end. CONCLUSIONS: Our results support the hypothesis that androgens may be transported along the wolffian duct. Secretion of testicular hormones into the wolffian duct may maintain hormone levels in the biologically active range.

A quail mesonephros was produced in a chicken embryo by orthotopic transplantation of quail left Wolffian duct and intermediate mesoderm between somites 18 and 21 in a 2 day chicken embryo. During the indifferent period of gonadal development in the chicken (day 4-6), no mesonephric (quail) cells take part in forming gonadal somatic cells. At this period all these cells are derived from the surface epithelium. The epithelial cells leave the surface where colonization of primordial germ cells occurs. The mesonephros begins its participation in gonadal soma formation between day 6 and 7, the time of sexual differentiation. These results are discussed in terms of sexual differentiation and the development stage of the mesonephros.

Two unusual ovarian tumours thought to be of Wolffian identity, one of them malignant, are described. They showed packed combinations of adenopapillary, tubular, trabecular and diffuse patterns, a sharp and generalised periodic acid-Schiff (PAS)-positive basement membrane and areas of elastic network. A review of published Wolffian tumours at various sites suggests that the prototypes of the two tumours occur chiefly in the cervix and broad ligament. The significance of Wolffian tumours and their differentiation from arrhenoblastoma and serous tumours is discussed.