Large multilocular cystic lesions in the uterine cervix: Differential diagnosis and significance

Abstract

Introduction:Cervical nabothian cysts are common in women of reproductive age. Although cysts are generally small and asymptomatic, large ones are extremely rare and may be misdiagnosed as malignancy.Case Study:We report a case of large multiple complex nabothian cyst, which was suspected as malignant one on imaging and examination. Pelvic examination and ultrasonography revealed ballooned cervix with multiple large complex nabothian follicles. There was an associated large adnexal mass with ascites. The patient was treated with total hysterectomy and omentectomy after aspiration of the fluid from the cervical cysts for debulking and limiting complications. Pathology revealed granulosa cell ovarian tumor, omental panniculitis, and cervical nabothian follicles.Conclusion:Large nabothian cysts should be kept in mind for differential diagnosis of cervical tumors. Ultrasonography is of value for the diagnosis of giant nabothian cysts and can aid in exclusion of malignancy. Differentiation between a malignant cystic lesion, such as an adenoma malignum, and a benign cystic lesion is crucial but difficult. Cervical nabothian follicles can be multiple and attain a large size up to 4 cm each. It is commonly benign but we should keep in mind the rare adenoma malignum on imaging and histopathology.

Giant nabothian cysts: A rare incidental diagnosis on MRI

“…Moreover, benign lesions do not show wall enhancement with intravenous gadolinium [11] . Thus, a small size and distinct boundaries without enhancement are characteristic findings of nabothian cysts on MR [8 , 10 , 11] . On CT nabothian cysts have fluid attenuation (0-20 HU) and their differentiation from other regional cystic lesions (such as Gartner's duct cyst, adnexal cystic lesions, or cystic neoplasms), even on a contrast enhanced study, may be challenging.…”

“…On imaging, nabothian cysts appear as cystic accumulation within the cervical stroma with round and regular boundaries [8 , 9] . They present with posterior acoustic enhancement on ultrasound [8 , 9] . Doppler imaging shows no intralesional vascularity [10] .…”

Cytological and Bacteriological Assessment of the Cervix in Cases Having Nabothian Cysts

“…Pelvic pain can have various causes, and in the case of Nabothian cysts, it may be related to the size and location of the cysts. Larger or symptomatic cysts can exert pressure on surrounding tissues, leading to discomfort or pain (4,14) . Regarding the characteristics of cervical Nabothian cysts within the study group: In terms of the size: 32 (32%) participants had cysts smaller than 10 mm.…”

“…Large and extensive cysts are located deeper in the cervix. The nabothian cyst tunnel cluster is observed as a result of multicystic dilatation of the endocervical glands (4) . Nabothian cysts rarely cause any problems and need no treatment.…”

Nabothian cyst association with infertility in female by trans-abdominal and trans-vaginal ultrasound

“…13 Obstructed labor or cervical prolapses have been reported in some cases with a large nabothian cyst. [14][15][16] Ultrasound plays an important role in diagnosing the cause of infertility .An nabothian cyst appears on ultrasound as a cystic lesion in cervix, rounded with well-defined margin, [17][18] anechoic with posterior acoustic enhancement and appear avascular on color Doppler. [9][10][11][12][13][14][15][16][17][18][19] Ultrasounds, either transabdominal or transvaginal, are first line imaging for female pelvic organs demonstration, 20 the probe is placed into the vagina for a few centimeters for the demonstration of the cervix.…”