Vaginal cysts

Vaginal cysts are uncommon benign cysts that develop in the vaginal wall.[1][2] The type of epithelial tissue lining a cyst is used to classify these growths.[3] They can be congenital.[4][5][6][7] They can present in childhood and adulthood.[7] The most common type is the squamous inclusion cyst. It develops within vaginal tissue present at the site of an episiotomy or other vaginal surgical sites.[7][8] In most instances they do not cause symptoms and present with few or no complications.[8][4] A vaginal cyst can develop on the surface of the vaginal epithelium or in deeper layers. Often, they are found by the woman herself and as an incidental finding during a routine pelvic examination.[8][9][10][3] Vaginal cysts can mimic other structures that protrude from the vagina such as a rectocele and cystocele.[1][11] Some cysts can be distinguished visually but most will need a biopsy to determine the type.[8][12] Vaginal cysts can vary in size and can grow as large as 7 cm.[1][13] Other cysts can be present on the vaginal wall though mostly these can be differentiated.[8][14] Vaginal cysts can often be palpated (felt) by a clinician. Vaginal cysts are one type of vaginal mass, others include cancers and tumors.[15] The prevalence of vaginal cysts is uncertain since many go unreported but it is estimated that 1 out of 200 women have a vaginal cyst.[1][10] Vaginal cysts may initially be discovered during pregnancy and childbirth. These are then treated to provide an unobstructed delivery of the infant.[1] Growths that originate from the urethra and other tissue can present as cysts of the vagina.[16]

A 1906 illustration of a Gartner cyst on the vaginal wall

Types

Vaginal inclusion cysts can appear as small bumps and can develop during childbirth, or after surgery.[8] A squamous inclusion cyst can rarely be found in a newborn.[7] Other cysts can be Bartholin's cysts, Gartner's duct cysts, mucous inclusions, epithelial inclusion cysts, embryonic cysts and urothelial cysts.[1][17] Less common vaginal cysts are endometrial cysts and vaginitis emphysematosa. Vaginitis emphysematosum is a group of gas-filled cysts on the vaginal wall; these are benign and self-limiting (resolve on their own).[16][17][7] Vaginal cysts can also be congenital and associated with urinary system anomalies [18][19][20]

The most common type of vaginal cyst are Müllerian cysts. These usually develop on the anterolateral vaginal wall.[1] This cyst can be lined with epithelium from the cervix, uterus and Fallopian tubes.[21]

An epithelial inclusion cyst is also referred to as epidermal inclusion cyst or squamous inclusion cyst.[22][10] This type of cyst comprises 23% of all vaginal cysts and is the second most common. This cyst originates from epithelium tissue that has been 'trapped' from surgery, episiotomy, or other trauma. It is most often found on the lower posterior vaginal wall.[22][2] An epidermoid cyst is one type of vaginal cyst.[23] Inclusion cysts are small and located on the posterior, lower end of the vagina. Small pieces of vaginal epithelium are trapped beneath the surface due to perineal lacerations and imperfect surgical repair after an episiotomy.[3]

A Gartner's duct cyst develops from a small tissue remnant of the mesonephric duct. Symptoms include: infection, bladder dysfunction, abdominal pain, vaginal discharge, and urinary incontinence.[11] It is often large enough to cause urinary incontinence but surgical removal provides treatment and recurrence is unlikely.[20][4] Diagnosis is confirmed with ultrasound imaging.[19] The evaluation by biopsy provides the most accurate diagnosis.[19] This cyst has a lining of epithelial tissue that varies from squamous to mucin-secreting transitional epithelium.[21]

Occasionally, a parasitic infection causes a vaginal cyst.[15]

Signs and symptoms

In most instances, symptoms are minimal or absent. Some women may experience vaginal pressure, discomfort, swelling, painful sex, or bleeding.[10] Cysts can also be sensitive and tender to the touch.[17]

Diagnosis

Diagnosis is aided by the use of ultrasound, CT scan, voiding cystourethrogram, and MRI.[10][24] Ultrasound findings may be the visualization of smooth margins of a fluid-filled structure.[15] Vaginal cysts resemble other structures that protrude from the vagina such as rectocele and cystocele. Histological assessment is needed to determine the specific type of cyst.[1] Vaginal cysts are often discovered during a routine pelvic exam or pap smear.[10][9] Cysts are also discovered during a bimanual exam.[15] Other structures that resemble vaginal cysts are connective tissue tumors, hematocolpos, and hymenal atresia.[15] The absence of vaginal rugae over the cyst is a clue to their presence.[3]

Treatment

Many cysts remain small, are followed closely by a clinician, and resolve on their own.[8] Surgery and/or drainage is performed to remove the cyst.[10] Treatment continues after the surgical removal by scheduled followups with the medical provider who looks for changes in the cyst.[8] Bartholin gland cysts often need to be drained. Sometimes, antibiotics are prescribed to treat them as well.[11] Treatment for these usually includes aspiration, marsupialisation and deroofing.[19][13][11] When cysts are treated complications are few. Vaginal cysts rarely recur. When surgically removed, the cysts usually do not return. In some cases a Bartholin cyst can develop and need further treatment.[8] In most cases, there are no complications from the cysts themselves. A surgical removal carries a small risk of complication. The risk depends on where the cyst is located.

See also

References
  1. Lallar M, Nandal R, Sharma D, Shastri S (January 2015). "Large posterior vaginal cyst in pregnancy". BMJ Case Reports. 2015: bcr2014208874. doi:10.1136/bcr-2014-208874. PMC 4307045. PMID 25604504.
  2. "Benign Neoplasms of the Vagina | GLOWM". www.glowm.com. Retrieved 2018-03-01.
  3. Jaya Prakash, Sheela; M, Lakshmi devi; G, Sampath Kumar (2011-07-04). "A rare case of posterior vaginal wall cyst". BMJ Case Reports. 2011: bcr0220113804. doi:10.1136/bcr.02.2011.3804. ISSN 1757-790X. PMC 3132834. PMID 22693290.
  4. Dey, Pranab (2017-02-06). Essentials of Gynecologic Pathology. JP Medical Ltd. p. 41. ISBN 9789386261205.
  5. Shimizu, Masaki; Imai, Toshihiro (2013). "Vaginal Cyst in a Newborn". The Journal of Pediatrics. 163 (6): 1790. doi:10.1016/j.jpeds.2013.07.043. PMID 24018015.
  6. Merlob P, Bahari C, Liban E, Reisner SH (November 1978). "Cysts of the female external genitalia in the newborn infant". Am. J. Obstet. Gynecol. 132 (6): 607–10. doi:10.1016/0002-9378(78)90851-7. PMID 568882.
  7. Heller, Debra S. (2012). "Vaginal Cysts". Journal of Lower Genital Tract Disease. 16 (2): 140–144. doi:10.1097/lgt.0b013e3182320ef0. PMID 22126833. S2CID 826917.
  8. "Vaginal cysts: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2018-02-17.
  9. Elsayes KM, Narra VR, Dillman JR, Velcheti V, Hameed O, Tongdee R, Menias CO (October 2007). "Vaginal masses: magnetic resonance imaging features with pathologic correlation". Acta Radiologica. 48 (8): 921–33. doi:10.1080/02841850701552926. PMID 17924224. S2CID 31444644.
  10. Nucci, Marisa R.; Oliva, Esther (2009-01-01). Gynecologic Pathology. Elsevier Health Sciences. p. 96. ISBN 978-0443069208.
  11. Rios SS, Pereira LC, Santos CB, Chen AC, Chen JR, de Fátima B Vogt M (June 2016). "Conservative treatment and follow-up of vaginal Gartner's duct cysts: a case series". J Med Case Rep. 10 (1): 147. doi:10.1186/s13256-016-0936-1. ISSN 1752-1947. PMC 4890494. PMID 27256294.
  12. Nelson, Philippa (2018-01-23). "Endometriosis presenting as a vaginal mass". BMJ Case Reports. 2018: bcr–2017–222431. doi:10.1136/bcr-2017-222431. ISSN 1757-790X. PMC 5786902. PMID 29367370.
  13. Arumugam A, Kumar G, Si L, Vijayananthan A (October 2007). "Gartner duct cyst in pregnancy presenting as a prolapsing pelvic mass". Biomedical Imaging and Intervention Journal. 3 (4): e46. doi:10.2349/biij.3.4.e46. PMC 3097688. PMID 21614298.
  14. Kondi-Pafiti A, Grapsa D, Papakonstantinou K, Kairi-Vassilatou E, Xasiakos D (2008). "Vaginal cysts: a common pathologic entity revisited". Clinical and Experimental Obstetrics & Gynecology. 35 (1): 41–4. PMID 18390079.
  15. Merz, Eberhard (2005). Ultrasound in Obstetrics and Gynecology. Thieme. p. 30. ISBN 9783137544029.
  16. Eilber KS, Raz S (September 2003). "Benign cystic lesions of the vagina: a literature review". J. Urol. 170 (3): 717–22. doi:10.1097/01.ju.0000062543.99821.a2. PMID 12913681.
  17. Firoozi, Farzeen (2014-10-16). Female Pelvic Surgery. Springer. p. 206. ISBN 9781493915040.
  18. Heller DS (April 2012). "Vaginal cysts: a pathology review". Journal of Lower Genital Tract Disease. 16 (2): 140–4. doi:10.1097/LGT.0b013e3182320ef0. PMID 22126833. S2CID 826917.
  19. Tiwari C, Shah H, Desale J, Waghmare M (2017). "Neonatal Gartner Duct Cyst: Two Case Reports and Literature Review". Developmental Period Medicine. 21 (1): 35–37. PMC 8522989. PMID 28551690.
  20. Hoogendam JP, Smink M (April 2017). "Gartner's Duct Cyst". The New England Journal of Medicine. 376 (14): e27. doi:10.1056/NEJMicm1609983. PMID 28379795.
  21. Humphrey, Peter A.; Dehner, Louis P.; Pfeifer, John D. (2008). The Washington Manual of Surgical Pathology. Lippincott Williams & Wilkins. p. 449. ISBN 9780781765275.
  22. Ostrzenski, Adam (2002). Gynecology: Integrating Conventional, Complementary, and Natural Alternative Therapy. Lippincott Williams & Wilkins. ISBN 9780781727617.
  23. Zimmern PE, Norton PA, Haab F, Chapple CR, eds. (2006). Vaginal Surgery for Incontinence and Prolapse. Springer Science & Business Media. p. 271. ISBN 978-1852339128. Retrieved March 2, 2018.
  24. Kruger, Petrus Frans; Rahmani, Rose; Kung, Rose (2015). "2077416 Skene's Gland Duct Cysts: the Utility of Vaginal/Transperineal Imaging In Diagnosis And Mapping For Surgery. a Case Series And Review of The Literature". Ultrasound in Medicine & Biology. 41 (4): S119–S120. doi:10.1016/j.ultrasmedbio.2014.12.479.
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