#Ultrasound Imaging of a Large Nabothian Cyst of Cervix
Nabothian cysts are benign cysts that form in the cervix, the lower part of the uterus. They are caused by the blockage of cervical mucus-producing gland cells. They are very common and usually do not cause any symptoms or complications. However, sometimes they can grow large enough to be seen on ultrasound imaging or interfere with cervical screening tests.
In this blog post, I will share a case of a 35-year-old female patient who underwent an ultrasound scan and was found to have a large Nabothian cyst of cervix.
# Case Presentation:
The patient presented with no complaints or history of cervical pathology. She had regular menstrual cycles and no history of sexually transmitted infections. She had one previous normal vaginal delivery.
# Ultrasound imaging:
She underwent a routine pelvic ultrasound scan as part of her annual health check-up. The scan revealed a well-defined, round, anechoic (black) cystic lesion measuring 1.4 cm in diameter in the anterior wall of the cervix (Figure 1). The cyst showed no internal vascularity on color Doppler ultrasound (Figure 2). The rest of the pelvic organs were normal.
Figure 1: Transabdominal ultrasound image showing a large nabothian cyst (arrow) in the anterior wall of the cervix.
Figure 2: Color Doppler ultrasound image showing no internal blood flow within the nabothian cyst.
# Differential Diagnoses
The differential diagnoses for a cystic lesion in the cervix include:
- Nabothian cyst: This is the most likely diagnosis in this case, given the typical appearance and location of the cyst. Nabothian cysts are usually small (<1 cm), but they can occasionally grow larger (>2 cm) ¹. They are usually asymptomatic, but they can cause pelvic pain, dyspareunia (painful intercourse), abnormal vaginal bleeding or discharge, or difficulty in urination or defecation if they compress adjacent structures ².
- Cervical polyp: This is a benign growth that protrudes from the cervical canal into the vagina. It can be pedunculated (attached by a stalk) or sessile (flat). It can be single or multiple. It usually appears as a hypoechoic (gray) mass with internal vascularity on ultrasound ³. It can cause intermenstrual or postcoital bleeding, vaginal discharge, or infertility ⁴.
- Cervical cancer: This is a malignant tumor that arises from the cells lining the cervix. It can be squamous cell carcinoma (the most common type), adenocarcinoma, or other rare types. It can present as a solid or cystic mass with irregular margins and increased vascularity on ultrasound ⁵. It can cause abnormal vaginal bleeding or discharge, pelvic pain, weight loss, or metastatic symptoms ⁶.
- Endometrioma: This is a benign cyst that contains endometrial tissue (the lining of the uterus) outside the uterus. It can occur in various locations in the pelvis, including the cervix. It usually appears as a complex cyst with low-level echoes and fine septations on ultrasound ⁷. It can cause dysmenorrhea (painful periods), dyspareunia, chronic pelvic pain, or infertility ⁸.
- Other rare causes: These include cervical leiomyoma (fibroid), cervical abscess (infection), cervical ectopic pregnancy (implantation of a fertilized egg in the cervix), cervical lymphangioma (a benign tumor of lymphatic vessels), cervical dermoid cyst (a benign tumor that contains various types of tissues), or cervical metastasis (spread of cancer from another site) ⁹.
# Prognosis and Management:
The prognosis of nabothian cysts is excellent. They are not associated with any increased risk of malignancy or adverse pregnancy outcomes. They usually do not require any treatment unless they cause symptoms or interfere with cervical screening tests.
The management options for symptomatic or large nabothian cysts include:
- Observation: This is suitable for asymptomatic or mildly symptomatic cysts that do not interfere with cervical screening tests. The cysts may resolve spontaneously over time or remain stable in size ¹¹.
- Aspiration: This involves inserting a needle into the cyst and draining the fluid out. This can be done under local anesthesia in the office or under general anesthesia in the operating room. This can provide immediate relief of symptoms, but the cyst may recur ¹².
- Excision: This involves surgically removing the cyst and the surrounding tissue. This can be done by various techniques, such as electrocautery, laser, or scalpel. This can be done under local or general anesthesia in the office or in the operating room. This can provide a definitive cure and prevent recurrence, but it may cause scarring or stenosis (narrowing) of the cervix ¹³.
#Conclusion
Nabothian cysts are common and benign cysts that form on the surface of the cervix. They usually do not cause any symptoms or complications and do not require any treatment. However, sometimes they can grow large enough to be seen on ultrasound imaging or interfere with cervical screening tests. In such cases, they can be managed by observation, aspiration, or excision, depending on the patient's preference and reproductive plans.
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(2) Nabothian Cyst: Causes, Symptoms, and Treatments - Healthline. https://www.healthline.com/health/nabothian-cyst.
(3) Nabothian cyst: Causes, symptoms, complications, and treatment. https://www.medicalnewstoday.com/articles/327061.
(4) Nabothian Cysts - Harvard Health. https://www.health.harvard.eduwww.health.harvard.edu/a_to_z/nabothian-cysts-a-to-z.
(5) Nabothian cyst - Wikipedia. https://en.wikipedia.org/wiki/Nabothian_cyst.
(6) Differential diagnosis of a neck mass - UpToDate. https://www.uptodate.com/contents/differential-diagnosis-of-a-neck-mass.
(7) Differential diagnosis of cervical cystic lesions
(11) Nabothian Cysts: Definition, Symptoms, Prognosis - Verywell Health. https://www.verywellhealth.com/nabothian-cysts-7107592.
(12) Nabothian cyst | Radiology Reference Article | Radiopaedia.org. https://radiopaedia.org/articles/nabothian-cyst.
(13) undefined. https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms.
(14) undefined. https://dx.doi.org/10.26044/ecr2022/C-16617.
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