Application of 3D printing in the evaluation of a clinically significant congenital uterine anomaly

Congenital uterine anomalies are the result of abnormal development of the Müllerian ducts and occur in approximately 5% of the general female population. These malformations often remain asymptomatic and undiagnosed until complications arise, especially during reproductive years. Accurate diagnosis and classification are crucial for counseling, reproductive planning, and appropriate surgical management. Recent advances in three-dimensional (3D) imaging and printing technology have enhanced diagnostic and therapeutic strategies in complex gynecologic cases. This report aims to present a rare postpartum complication associated with a congenital uterine anomaly, characterize the histopathological and radiological features of the case, and assess the role of printed three-dimensional (3D) anatomical modeling in supporting accurate post hoc classification and surgical decision-making.

A 25-year-old primiparous woman with a congenital uterine malformation underwent cesarean section at 28 weeks of gestation due to premature rupture of membranes and regular uterine contractions. One month postpartum, the patient presented with vaginal discharge and reported a palpable resistance in the vagina. Pelvic examination revealed a lobulated, dark pink, nonbleeding, firm mass measuring approximately 15 × 10 cm protruding into the vagina, along with an intact vaginal septum located 2-3 cm from the introitus. Ultrasound demonstrated an irregular mass in the right uterine cavity with indistinct margins suggestive of a necrotic fibroid. The patient underwent surgery involving removal of the vaginal mass and resection of the vaginal septum. Histopathological examination revealed fascicularly arranged, shadowed spindle cells consistent with necrotic smooth muscle tissue of myometrial origin, indicative of degenerative tissue of the uterine septum. Subsequently, a patient-specific 3D printed uterine model was generated using imaging and surgical data to facilitate detailed postoperative anatomical assessment.

Postoperative assessment using the 3D printed model enabled a precise classification of the malformation as a "double septate uterus with cervix and septate vagina" (ESHRE/ESGE classification U2bC2V1) with an intracavitary FIGO type 2 submucosal leiomyoma. The 3D model provided a tangible visualization of the uterine architecture, improving anatomical understanding, facilitating retrospective diagnosis, and supporting interdisciplinary evaluation.

This case demonstrates the diagnostic and educational utility of 3D printing in the management of rare Müllerian anomalies. Integration of patient-specific 3D models into clinical practice may improve diagnostic precision and surgical planning, particularly in complex gynecological malformations.