Magnetic resonance imaging features of complete androgen insensitivity syndrome in comparison to Mayer-Rokitansky-Küster-Hauser syndrome
Purpose Complete androgen insensitivity syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) share common clinical features such as female phenotype, vaginal hypoplasia, and primary amenorrhea. Magnetic resonance imaging (MRI) is performed to investigate the cause of primary amenorrhe...
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| Veröffentlicht in: | Abdominal imaging 2024-09, Vol.49 (9), p.3220-3231 |
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| creator | Nakamata, Akihiro Matsuki, Mitsuru Otake, Yuko Himoto, Yuki Kaneko, Yo Nakaya, Moto Sudo, Naohiro Kikuchi, Tomohiro Watanabe, Yuriko Kobayashi, Ryoma Masuoka, Sota Kunitomo, Naoki Fujii, Hiroyuki Hamamoto, Kohei Mori, Harushi |
| description | Purpose
Complete androgen insensitivity syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) share common clinical features such as female phenotype, vaginal hypoplasia, and primary amenorrhea. Magnetic resonance imaging (MRI) is performed to investigate the cause of primary amenorrhea. However, the MRI features are also similar in both disorders. They are ultimately diagnosed by chromosome testing, but there is a possibility of misdiagnosis if chromosome testing is not performed. This study aimed to identify MRI features that are useful for differentiating CAIS from MRKHS.
Method
This multicenter retrospective study included 12 patients with CAIS and 19 patients with MRKHS. Three radiologists blindly evaluated the following features: (1) detection of vagina, (2) detection of nodular and cystic structures in the lateral pelvis; undescended testicles and paratesticular cysts in CAIS and rudimentary uteri and ovaries in MRKHS, (3) their location, (4) number of cysts in the cystic structures, and (5) signal intensity on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values of the nodular structures. Statistical comparisons were performed using Mann–Whitney U and Fisher’s exact tests.
Results
Compared with MRKHS, the CAIS group showed significantly detectable vagina, more ventrally located nodular and cystic structures, fewer cysts within the cystic structures, and nodular structures with higher signal intensity on DWI and lower ADC values.
Conclusions
MRI features of detectable vagina, location of nodular and cystic structures, number of cysts within the cystic structures, signal intensity on DWI and ADC values of the nodular structures were useful in differentiating CAIS from MRKHS.
Graphical Abstract |
| doi_str_mv | 10.1007/s00261-024-04282-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3037395226</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3037395226</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-edefea64636a7b90f2c722e64e24ec4349dde883857e281b2aa71fbb5ed5a1c43</originalsourceid><addsrcrecordid>eNp9kcFqFjEUhYMottS-gAsJuHETm9xMMjNLKWrFlkKp65CZuTOk_Sf5TTLC9A18J3e-mGn_thYXrhJOvnPuJYeQ14K_F5zXR4lz0IJxqBivoAF284zsg9Saca6a50_ue-QwpSvOudBKCFAvyZ5sNAcFYp_8PLOTx-x6GjEFb32P1M12cn6iI9q8FJmGkfZh3m4wI7V-iGFCT51P6JPL7ofLK03rrT4Xs79jbXQljuZAz-yKkV2Ea5etT9cr-_r7V8pFOrFLwvjofEVejHaT8PD-PCDfPn28PD5hp-efvxx_OGW9BJ0ZDlj20pWW2tZdy0foawDUFUKFfSWrdhiwaWSjaoRGdGBtLcauUzgoKwpwQN7tcrcxfF8wZTO71ONmYz2GJRnJZS1bBaAL-vYf9Cos0ZftCtVWrdBcqELBjupjSCniaLaxfGFcjeDmtiuz68qUrsxdV-ammN7cRy_djMOj5aGZAsgdkMqTnzD-nf2f2D8asaO4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3094916015</pqid></control><display><type>article</type><title>Magnetic resonance imaging features of complete androgen insensitivity syndrome in comparison to Mayer-Rokitansky-Küster-Hauser syndrome</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Nakamata, Akihiro ; Matsuki, Mitsuru ; Otake, Yuko ; Himoto, Yuki ; Kaneko, Yo ; Nakaya, Moto ; Sudo, Naohiro ; Kikuchi, Tomohiro ; Watanabe, Yuriko ; Kobayashi, Ryoma ; Masuoka, Sota ; Kunitomo, Naoki ; Fujii, Hiroyuki ; Hamamoto, Kohei ; Mori, Harushi</creator><creatorcontrib>Nakamata, Akihiro ; Matsuki, Mitsuru ; Otake, Yuko ; Himoto, Yuki ; Kaneko, Yo ; Nakaya, Moto ; Sudo, Naohiro ; Kikuchi, Tomohiro ; Watanabe, Yuriko ; Kobayashi, Ryoma ; Masuoka, Sota ; Kunitomo, Naoki ; Fujii, Hiroyuki ; Hamamoto, Kohei ; Mori, Harushi</creatorcontrib><description>Purpose
Complete androgen insensitivity syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) share common clinical features such as female phenotype, vaginal hypoplasia, and primary amenorrhea. Magnetic resonance imaging (MRI) is performed to investigate the cause of primary amenorrhea. However, the MRI features are also similar in both disorders. They are ultimately diagnosed by chromosome testing, but there is a possibility of misdiagnosis if chromosome testing is not performed. This study aimed to identify MRI features that are useful for differentiating CAIS from MRKHS.
Method
This multicenter retrospective study included 12 patients with CAIS and 19 patients with MRKHS. Three radiologists blindly evaluated the following features: (1) detection of vagina, (2) detection of nodular and cystic structures in the lateral pelvis; undescended testicles and paratesticular cysts in CAIS and rudimentary uteri and ovaries in MRKHS, (3) their location, (4) number of cysts in the cystic structures, and (5) signal intensity on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values of the nodular structures. Statistical comparisons were performed using Mann–Whitney U and Fisher’s exact tests.
Results
Compared with MRKHS, the CAIS group showed significantly detectable vagina, more ventrally located nodular and cystic structures, fewer cysts within the cystic structures, and nodular structures with higher signal intensity on DWI and lower ADC values.
Conclusions
MRI features of detectable vagina, location of nodular and cystic structures, number of cysts within the cystic structures, signal intensity on DWI and ADC values of the nodular structures were useful in differentiating CAIS from MRKHS.
Graphical Abstract</description><identifier>ISSN: 2366-0058</identifier><identifier>ISSN: 2366-004X</identifier><identifier>EISSN: 2366-0058</identifier><identifier>DOI: 10.1007/s00261-024-04282-z</identifier><identifier>PMID: 38602521</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>46, XX Disorders of Sex Development - diagnostic imaging ; Adolescent ; Adult ; Amenorrhea ; Androgen-Insensitivity Syndrome - diagnostic imaging ; Androgens ; Child ; Chromosomes ; Congenital Abnormalities - diagnostic imaging ; Cysts ; Diagnosis, Differential ; Diffusion coefficient ; Female ; Gastroenterology ; Hepatology ; Humans ; Hypoplasia ; Imaging ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Male ; Medical imaging ; Medicine ; Medicine & Public Health ; Mullerian Ducts - abnormalities ; Mullerian Ducts - diagnostic imaging ; Ovaries ; Pelvis ; Phenotypes ; Radiology ; Retrospective Studies ; Statistical analysis ; Vagina ; Vagina - abnormalities ; Vagina - diagnostic imaging ; Young Adult</subject><ispartof>Abdominal imaging, 2024-09, Vol.49 (9), p.3220-3231</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-edefea64636a7b90f2c722e64e24ec4349dde883857e281b2aa71fbb5ed5a1c43</cites><orcidid>0000-0002-7431-004X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00261-024-04282-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00261-024-04282-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38602521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nakamata, Akihiro</creatorcontrib><creatorcontrib>Matsuki, Mitsuru</creatorcontrib><creatorcontrib>Otake, Yuko</creatorcontrib><creatorcontrib>Himoto, Yuki</creatorcontrib><creatorcontrib>Kaneko, Yo</creatorcontrib><creatorcontrib>Nakaya, Moto</creatorcontrib><creatorcontrib>Sudo, Naohiro</creatorcontrib><creatorcontrib>Kikuchi, Tomohiro</creatorcontrib><creatorcontrib>Watanabe, Yuriko</creatorcontrib><creatorcontrib>Kobayashi, Ryoma</creatorcontrib><creatorcontrib>Masuoka, Sota</creatorcontrib><creatorcontrib>Kunitomo, Naoki</creatorcontrib><creatorcontrib>Fujii, Hiroyuki</creatorcontrib><creatorcontrib>Hamamoto, Kohei</creatorcontrib><creatorcontrib>Mori, Harushi</creatorcontrib><title>Magnetic resonance imaging features of complete androgen insensitivity syndrome in comparison to Mayer-Rokitansky-Küster-Hauser syndrome</title><title>Abdominal imaging</title><addtitle>Abdom Radiol</addtitle><addtitle>Abdom Radiol (NY)</addtitle><description>Purpose
Complete androgen insensitivity syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) share common clinical features such as female phenotype, vaginal hypoplasia, and primary amenorrhea. Magnetic resonance imaging (MRI) is performed to investigate the cause of primary amenorrhea. However, the MRI features are also similar in both disorders. They are ultimately diagnosed by chromosome testing, but there is a possibility of misdiagnosis if chromosome testing is not performed. This study aimed to identify MRI features that are useful for differentiating CAIS from MRKHS.
Method
This multicenter retrospective study included 12 patients with CAIS and 19 patients with MRKHS. Three radiologists blindly evaluated the following features: (1) detection of vagina, (2) detection of nodular and cystic structures in the lateral pelvis; undescended testicles and paratesticular cysts in CAIS and rudimentary uteri and ovaries in MRKHS, (3) their location, (4) number of cysts in the cystic structures, and (5) signal intensity on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values of the nodular structures. Statistical comparisons were performed using Mann–Whitney U and Fisher’s exact tests.
Results
Compared with MRKHS, the CAIS group showed significantly detectable vagina, more ventrally located nodular and cystic structures, fewer cysts within the cystic structures, and nodular structures with higher signal intensity on DWI and lower ADC values.
Conclusions
MRI features of detectable vagina, location of nodular and cystic structures, number of cysts within the cystic structures, signal intensity on DWI and ADC values of the nodular structures were useful in differentiating CAIS from MRKHS.
Graphical Abstract</description><subject>46, XX Disorders of Sex Development - diagnostic imaging</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Amenorrhea</subject><subject>Androgen-Insensitivity Syndrome - diagnostic imaging</subject><subject>Androgens</subject><subject>Child</subject><subject>Chromosomes</subject><subject>Congenital Abnormalities - diagnostic imaging</subject><subject>Cysts</subject><subject>Diagnosis, Differential</subject><subject>Diffusion coefficient</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Hypoplasia</subject><subject>Imaging</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mullerian Ducts - abnormalities</subject><subject>Mullerian Ducts - diagnostic imaging</subject><subject>Ovaries</subject><subject>Pelvis</subject><subject>Phenotypes</subject><subject>Radiology</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Vagina</subject><subject>Vagina - abnormalities</subject><subject>Vagina - diagnostic imaging</subject><subject>Young Adult</subject><issn>2366-0058</issn><issn>2366-004X</issn><issn>2366-0058</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcFqFjEUhYMottS-gAsJuHETm9xMMjNLKWrFlkKp65CZuTOk_Sf5TTLC9A18J3e-mGn_thYXrhJOvnPuJYeQ14K_F5zXR4lz0IJxqBivoAF284zsg9Saca6a50_ue-QwpSvOudBKCFAvyZ5sNAcFYp_8PLOTx-x6GjEFb32P1M12cn6iI9q8FJmGkfZh3m4wI7V-iGFCT51P6JPL7ofLK03rrT4Xs79jbXQljuZAz-yKkV2Ea5etT9cr-_r7V8pFOrFLwvjofEVejHaT8PD-PCDfPn28PD5hp-efvxx_OGW9BJ0ZDlj20pWW2tZdy0foawDUFUKFfSWrdhiwaWSjaoRGdGBtLcauUzgoKwpwQN7tcrcxfF8wZTO71ONmYz2GJRnJZS1bBaAL-vYf9Cos0ZftCtVWrdBcqELBjupjSCniaLaxfGFcjeDmtiuz68qUrsxdV-ammN7cRy_djMOj5aGZAsgdkMqTnzD-nf2f2D8asaO4</recordid><startdate>20240901</startdate><enddate>20240901</enddate><creator>Nakamata, Akihiro</creator><creator>Matsuki, Mitsuru</creator><creator>Otake, Yuko</creator><creator>Himoto, Yuki</creator><creator>Kaneko, Yo</creator><creator>Nakaya, Moto</creator><creator>Sudo, Naohiro</creator><creator>Kikuchi, Tomohiro</creator><creator>Watanabe, Yuriko</creator><creator>Kobayashi, Ryoma</creator><creator>Masuoka, Sota</creator><creator>Kunitomo, Naoki</creator><creator>Fujii, Hiroyuki</creator><creator>Hamamoto, Kohei</creator><creator>Mori, Harushi</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>FR3</scope><scope>JQ2</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7431-004X</orcidid></search><sort><creationdate>20240901</creationdate><title>Magnetic resonance imaging features of complete androgen insensitivity syndrome in comparison to Mayer-Rokitansky-Küster-Hauser syndrome</title><author>Nakamata, Akihiro ; Matsuki, Mitsuru ; Otake, Yuko ; Himoto, Yuki ; Kaneko, Yo ; Nakaya, Moto ; Sudo, Naohiro ; Kikuchi, Tomohiro ; Watanabe, Yuriko ; Kobayashi, Ryoma ; Masuoka, Sota ; Kunitomo, Naoki ; Fujii, Hiroyuki ; Hamamoto, Kohei ; Mori, Harushi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-edefea64636a7b90f2c722e64e24ec4349dde883857e281b2aa71fbb5ed5a1c43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>46, XX Disorders of Sex Development - diagnostic imaging</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Amenorrhea</topic><topic>Androgen-Insensitivity Syndrome - diagnostic imaging</topic><topic>Androgens</topic><topic>Child</topic><topic>Chromosomes</topic><topic>Congenital Abnormalities - diagnostic imaging</topic><topic>Cysts</topic><topic>Diagnosis, Differential</topic><topic>Diffusion coefficient</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Hypoplasia</topic><topic>Imaging</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mullerian Ducts - abnormalities</topic><topic>Mullerian Ducts - diagnostic imaging</topic><topic>Ovaries</topic><topic>Pelvis</topic><topic>Phenotypes</topic><topic>Radiology</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Vagina</topic><topic>Vagina - abnormalities</topic><topic>Vagina - diagnostic imaging</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nakamata, Akihiro</creatorcontrib><creatorcontrib>Matsuki, Mitsuru</creatorcontrib><creatorcontrib>Otake, Yuko</creatorcontrib><creatorcontrib>Himoto, Yuki</creatorcontrib><creatorcontrib>Kaneko, Yo</creatorcontrib><creatorcontrib>Nakaya, Moto</creatorcontrib><creatorcontrib>Sudo, Naohiro</creatorcontrib><creatorcontrib>Kikuchi, Tomohiro</creatorcontrib><creatorcontrib>Watanabe, Yuriko</creatorcontrib><creatorcontrib>Kobayashi, Ryoma</creatorcontrib><creatorcontrib>Masuoka, Sota</creatorcontrib><creatorcontrib>Kunitomo, Naoki</creatorcontrib><creatorcontrib>Fujii, Hiroyuki</creatorcontrib><creatorcontrib>Hamamoto, Kohei</creatorcontrib><creatorcontrib>Mori, Harushi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Computer Science Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Abdominal imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nakamata, Akihiro</au><au>Matsuki, Mitsuru</au><au>Otake, Yuko</au><au>Himoto, Yuki</au><au>Kaneko, Yo</au><au>Nakaya, Moto</au><au>Sudo, Naohiro</au><au>Kikuchi, Tomohiro</au><au>Watanabe, Yuriko</au><au>Kobayashi, Ryoma</au><au>Masuoka, Sota</au><au>Kunitomo, Naoki</au><au>Fujii, Hiroyuki</au><au>Hamamoto, Kohei</au><au>Mori, Harushi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Magnetic resonance imaging features of complete androgen insensitivity syndrome in comparison to Mayer-Rokitansky-Küster-Hauser syndrome</atitle><jtitle>Abdominal imaging</jtitle><stitle>Abdom Radiol</stitle><addtitle>Abdom Radiol (NY)</addtitle><date>2024-09-01</date><risdate>2024</risdate><volume>49</volume><issue>9</issue><spage>3220</spage><epage>3231</epage><pages>3220-3231</pages><issn>2366-0058</issn><issn>2366-004X</issn><eissn>2366-0058</eissn><abstract>Purpose
Complete androgen insensitivity syndrome (CAIS) and Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS) share common clinical features such as female phenotype, vaginal hypoplasia, and primary amenorrhea. Magnetic resonance imaging (MRI) is performed to investigate the cause of primary amenorrhea. However, the MRI features are also similar in both disorders. They are ultimately diagnosed by chromosome testing, but there is a possibility of misdiagnosis if chromosome testing is not performed. This study aimed to identify MRI features that are useful for differentiating CAIS from MRKHS.
Method
This multicenter retrospective study included 12 patients with CAIS and 19 patients with MRKHS. Three radiologists blindly evaluated the following features: (1) detection of vagina, (2) detection of nodular and cystic structures in the lateral pelvis; undescended testicles and paratesticular cysts in CAIS and rudimentary uteri and ovaries in MRKHS, (3) their location, (4) number of cysts in the cystic structures, and (5) signal intensity on diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values of the nodular structures. Statistical comparisons were performed using Mann–Whitney U and Fisher’s exact tests.
Results
Compared with MRKHS, the CAIS group showed significantly detectable vagina, more ventrally located nodular and cystic structures, fewer cysts within the cystic structures, and nodular structures with higher signal intensity on DWI and lower ADC values.
Conclusions
MRI features of detectable vagina, location of nodular and cystic structures, number of cysts within the cystic structures, signal intensity on DWI and ADC values of the nodular structures were useful in differentiating CAIS from MRKHS.
Graphical Abstract</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38602521</pmid><doi>10.1007/s00261-024-04282-z</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-7431-004X</orcidid></addata></record> |
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| subjects | 46, XX Disorders of Sex Development - diagnostic imaging Adolescent Adult Amenorrhea Androgen-Insensitivity Syndrome - diagnostic imaging Androgens Child Chromosomes Congenital Abnormalities - diagnostic imaging Cysts Diagnosis, Differential Diffusion coefficient Female Gastroenterology Hepatology Humans Hypoplasia Imaging Magnetic resonance imaging Magnetic Resonance Imaging - methods Male Medical imaging Medicine Medicine & Public Health Mullerian Ducts - abnormalities Mullerian Ducts - diagnostic imaging Ovaries Pelvis Phenotypes Radiology Retrospective Studies Statistical analysis Vagina Vagina - abnormalities Vagina - diagnostic imaging Young Adult |
| title | Magnetic resonance imaging features of complete androgen insensitivity syndrome in comparison to Mayer-Rokitansky-Küster-Hauser syndrome |
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