Can a case of uterine didelphis occur in which both uteri have a pair of tubes and ovaries? In other words, is there any known case of the paramesonephric duct bifurcating twice in succession two form two uteri each with two tubes (and each tube acquiring associated ovaries)?
A uterus didelphys is a double uterus sometimes associated with a double cervix. In approximately 75% of cases, a thin wall separates the vagina into two parts as well
In pregnancy a bifid uterus may not enlarge normally and lead to fetal loss, or a normal vaginal delivery may not be possible with a double cervix or vagina.
Incomplete fusion of the paramesonephric ducts results in the most common types of uterine malformation that occur in 1-5% of women. The appearance is that of two unicornuate uteri.
Failure of degeneration of the septum may result in septae of varying lengths including septation extending into the upper vagina resulting in a uterus didelphys with double upper vagina, cervix and endometrial cavity
I have been unable to find a case in the literature of a paramesonephric duct bifurcating on it rostral end leading to four uterine tubes rather than one uterine tube from each paramesonephric duct.
Since the ovarian blastemal cells are of mesonephric origin and not from the paramesonephric duct it also seems unlikely to see duplication of the ovaries along with duplication of the uterine tubes (4 ovaries, 4 uterine tubes)
Even in the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, characterized by congenital absence of the vagina, with bilateral nonfunctional rudimentary uteri, ovarian function is normal suggesting the unrelatedness of the ovarian blastemal cells and the paramesonephric ducts.
Having said all the above it is always possible that you have a surgical specimen of an extremely rare case of duplication of the uterine tubes along with duplication of the ovaries. Careful examination of the specimen, dissection, photographs and even an MRI of the specimen may clarify the situation. It might be worth writing up as a case study.
Crosby WM, Hill, EC (1962) Embryology of the müllerian duct system. Obstet Gynecol 20 :507–515.
Kurman RJ (1994) Blaustein's Pathology of the Female Genital Tract, 4th ed. New York: Springer-Verlag, pp. 368
O’Rahilly R, Müller F (2001) Human Embryology & Teratology. 3rd ed. Wiley-Liss, New York. See Chapter 16. The Reproductive System and in that chapter the section on “The Female Ductal System”. An excellent section on Anomalies of the Female Ductal System.