case_images: PMC11699791_01
case_images: Hysterosalpingogram confirmation of uterus didelphys. A. Cannulation of the external cervical orifice of the left cervix and iodinated contrast revealing filling of the endometrial cavity with no filling defects. The dilation of the ampullary portion of the left fallopian tube, indicative of a non-permeable left hydrosalpinx, is also shown. B. Cannulation of the external cervical orifice of the right cervix and the filling of the endometrial cavity without defects and a normal calibre and appearance of the right fallopian tube with contrast exiting into the peritoneal cavity
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case_images: Fig1
case_images: The hysterosalpingogram confirmed the uterus didelphys (Fig. 1). Filling of the endometrial cavity was observed, which shows no filling defects (Fig. 1A). Secondly, the external cervical orifice of the right cervix was cannulated, with an injection of 8 ml of water-soluble iodinated contrast (Fig. 1B). The right fallopian tube displayed a normal calibre and appearance, demonstrating the exit of the contrast into the peritoneal cavity (Fig. 1B).
case_images: Histology of the endometrium from both uteri, left (A) and right (B, C and D) stained with MUM1 in immunohistology staining. MUM1-positive cells are indicated by black rings. A and B original magnification X10. C and D original magnification x20
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case_images: Fig2
case_images: CE in the right-sided uterus, demonstrating MUM1-positive staining for plasma cells, as depicted in Fig. 2B, C and D. Conversely, no MUM1 positive cells were found in the left-sided uterus (Fig. 2A).
case_images: Heatmap of bacteria relative abundance from vagina (V), left cervix (CL), right cervix (CR), left uterus (UL) and right uterus (UR). The maximum size of the circles indicates a relative microbial abundance grater than 1%
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case_images: Fig3
case_images: The relative microbial abundances for the different body sites (i.e., vagina, both cervixes and uteri) are shown in Fig. 3. However, in terms of endometrial microbiome, different microbial compositions were noted (Fig. 3). Concretely, the endometrial microbiome from the right was not dominated by lactobacilli (48.2%), but with other microbial genera like Streptococcus, Staphylococcus, Bacillus and Streptococcus comprising a larger percentage of the microbial composition (Fig. 3).
case_images: Principal coordinate analysis (PCoA) plot based on Bray-Curtis dissimilarity. Dots are positioned according to the distances between microbial communities in the different samples: vagina (V), left cervix (CL), right cervix (CR), left uterus (UL), and right uterus (UR)
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case_images: Fig4
case_images: A principal coordinate analysis (PCoA), based on Bray-Curtis distances measured the dissimilarity of microbial community compositions across various sample sites (Fig. 4).
case_images: Metabolomic profile of uterus didelphys. A. Venn diagram representing the numbers of metabolites identified in endometrial samples (Left uterus, UL; right uterus, UR). B. Bar chart illustrating the twenty metabolites with the greatest differences (absolute values) in log peak area detected between the samples (blue for right uterus (UR), orange for left uterus (UL)). The right panel evidences the Log10 differences in peak areas in absolutes values among UR and UL. Bars indicate the magnitude of differences for each metabolite.
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case_images: Fig5
case_images: Our comprehensive analysis revealed that both uteri primarily share the same metabolomic profile, with 815 common metabolites detected in both uteri (Fig. 5A). However, variations in the peak areas corresponding to individual compounds were observed between the samples (Fig. 5B).
case_images: The enriched metabolic pathways in the left (A) and right (B) uterus based on the group of metabolites that were uniquely detected in each uterus. This dotplot chart was done using the MetaboAnalyst 6.0 tool  (https://www.metaboanalyst.ca). The enrichment ratio was calculated as the number of hits within a particular metabolic pathway divided by the expected number of hits. P-values were obtained from the Student's t test univariate analysis after linear regression and pareto scaling normalization
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case_images: Fig6
case_images: Table S2). These metabolites were involved in different biochemical pathways, potentially reflecting different uterine microenvironments (Fig. 6).