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LETTER TO THE EDITOR  
Year : 2016  |  Volume : 26  |  Issue : 3  |  Page : 417-418
Embryogenesis of vagina and embryopathogenesis of Herlyn–Werner–Wunderlich syndrome


Department of Radiology, Seth GSMC and KEM Hospital, Mumbai, India

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Date of Web Publication14-Sep-2016
 

How to cite this article:
Aswani Y. Embryogenesis of vagina and embryopathogenesis of Herlyn–Werner–Wunderlich syndrome. Indian J Radiol Imaging 2016;26:417-8

How to cite this URL:
Aswani Y. Embryogenesis of vagina and embryopathogenesis of Herlyn–Werner–Wunderlich syndrome. Indian J Radiol Imaging [serial online] 2016 [cited 2020 Feb 23];26:417-8. Available from: http://www.ijri.org/text.asp?2016/26/3/417/190411
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.[2],[3],[4]

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),[3],[4] 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.[2],[3],[4] 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.

There are no conflicts of interest.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Ahmad Z, Goyal A, Das CJ, Deka D, Sharma R. Herlyn–Werner–Wunderlich syndrome presenting with infertility: Role of MRI in diagnosis. Indian J Radiol Imaging 2013;23:243-6.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Acién P. Embryological observations on the female genital tract. Hum Reprod 1992;7:437-45.  Back to cited text no. 2
    
3.
Sánchez-Ferrer ML, Acién MI, Sánchez del Campo F, Mayol-Belda MJ, Acién P. Experimental contributions to the study of the embryology of the vagina. Hum Reprod 2006;21:1623-8.  Back to cited text no. 3
    
4.
Bajaj SK, Misra R, Thukral BB, Gupta R. OHVIRA: Uterus didelphys, blind hemivagina and ipsilateral renal agenesis: Advantage MRI. J Hum Reprod Sci 2012;5:67-70.  Back to cited text no. 4
[PUBMED]  Medknow Journal  

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Correspondence Address:
Yashant Aswani
Department of Radiology, Seth GSMC and KEM Hospital, Mumbai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.190411

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