Cyst and endometriosis of the canal of Nuck: rare differentials for a female groin mass

Abstract

Cyst of the canal of Nuck is a rare abnormality of the female inguinal canal that can present similarly to a hernia. If incompletely obliterated, the patent canal of Nuck may predispose to an inguinal hernia or hydrocele due to direct communication with the abdominal cavity. Such defects are normally detected and repaired in early childhood but can also present later in adult life. We report the case of a 44-year-old woman who presents with a fluctuant, mobile and irreducible left-sided groin mass. Ultrasound of the groin identified a cystic structure in the canal of Nuck. The patient underwent successful open herniorrhaphy with excision of the cyst and mesh repair of the inguinal canal. Subsequent histopathological examination also revealed concurrent endometriosis of the canal of Nuck. A systematic approach to differential diagnoses for a female groin mass, further investigations and management are discussed.

The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis—A Case Report of an Adult Woman and Narrative Review of the Literature

“…In the available literature, only a few reports of cysts of the canal of Nuck have been published since its discovery [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. However, in recent years, the number of published cases regarding this topic has increased significantly.…”

“…The clinical presentation of a cyst of the canal of Nuck shows an inguinal or genital, painless or painful swelling, with no attending nausea or vomiting [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Some existing reports identify that the mass can be reduced manually [ 8 , 17 , 19 ], and shows no increase in volume when performing the Valsalva maneuver [ 14 , 19 ].…”

“…[ 6 , 7 ]. Other differential diagnoses for the cyst of the canal of Nuck are lymphadenopathy, cold abscesses, endometriosis of the round ligaments, ganglion cysts, varicosity of the round ligament and other vascular diseases, or neoplasms such as lipomata or leiomyomata [ 3 , 10 , 17 , 20 , 21 ]. An overview of important differential diagnoses of the cyst of the canal of Nuck is presented in Table 1 .…”

“…The origin of this disease is a pathology during embryogenesis [ 3 , 4 ]. Clinically, a female hydrocele typically manifests as a swelling in the groin or genital region [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], which allows for a variety of differential diagnoses. Due to its rarity, most health professionals are not aware of its existence and the cyst of the canal of Nuck is often misdiagnosed [ 7 , 8 , 9 , 12 , 23 ].…”

Female with multiple groin pathologies: inguinal hernia containing fallopian tube, obturator hernia and subcutaneous endometrioma

“…A groin lump appearing as a swelling at the inguinofemoral junction is a common surgical presentation in general practice and emergency departments. The clinical features of a groin mass vary in size, shape, tenderness and consistency, reflecting various possible underlying pathological processes, including hernias, infection, neoplasms, vascular or congenital abnormalities [ 1 , 2 ]. Groin hernias occur 9–12 times more frequently in males and only 9% of all hernia operations occur in females [ 3 , 4 ].…”