An Unusual Presentation of a Huge Nabothian Cyst of Cervix With Manifestation of Uterine Prolapse: A Case Report

Abstract

Background: Nabothian cysts are common benign cervical lesions in women of reproductive age. They usually occur due to childbirth or minor trauma; mostly are small and asymptomatic. However, huge nabothian cysts may have variable presentation and can even mimic malignancy thus, biopsy is recommended to rule out malignancy. The unusual presentation of nabothian cyst as uterine prolapse makes it a diagnostic challenge for management of the patient similar to the present case. Case report: We report a case of a huge nabothian cyst in a perimenopausal, multiparous woman who presented with complaints of something coming out of vagina suddenly after mild heavyweight lifting and pain abdomen. Pelvic examination revealed a second degree uterine prolapse with a large lump protruding outside the vagina. Transvaginal ultrasonography demonstrated a multicystic cervical mass of size 9.5 cm × 8.0 cm arising from the posterior lip of cervix that was protruding through the vaginal canal. After excision of mass, prolapse became first degree. Histopathologic diagnosis was a cervical nabothian cyst. Patient had persisting first degree uterine prolapse along with posterior vaginal wall prolapse on subsequent postoperative follow ups. Hence, vaginal hysterectomy with repair to the vaginal wall was performed later. Conclusion: The present case of nabothian cyst is reported for its unusual presentation as uterine prolapse. The risk factors for pelvic organ prolapse (POP) in the present case are advancing age, multiparity and perimenopausal status. The connective tissue and levator ani muscle became weak and the nabothian cyst unmasked the POP that was latent and asymptomatic by increasing the prolapse from first degree to second degree.

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

“…Vaginal discharge can be a common symptom associated with various gynaecological conditions, including cervical cysts. In the context of Nabothian cysts, the presence of mucusfilled cysts on the cervix can disrupt the normal cervical secretions, leading to an increase in vaginal discharge (13) . The high percentage (51%) of participants reporting pelvic pain as a complaint indicates that this symptom is also quite common among women with nabothian cysts.…”

Giant nabothian cysts: A rare incidental diagnosis on MRI

“…Some cysts may cause significant watery discharge and discomfort [1 , 3] . Cases have been reported of large nabothian cysts causing obstruction to labor passage or cervical prolapse [5] , [6] , [7] .…”

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.…”