Presentation
Unmarried and nulligravida patient came with complaints of lower abdominal pain on and off, hematuria and burning micturition.
Patient Data
T2W hyperintense, T1W hypointense, and STIR hyperintense cystic lesion without restricted diffusion is noted along the left lateral wall of the upper 2/3rd vagina causing mild compression and deviation of the vaginal lumen to the right. It measures 2.6 x 3.5 x 3.3 cm (AP x TR x CC) with volume of 16 cc. No abnormal enhancement / soft tissue component within the cystic lesion on T1 fat sat post contrast study. These features are suggestive of a benign vaginal cyst, possibly Gartner's cyst.
The uterus and cervix appear normal.
The urinary bladder is empty.
The patient underwent cyst excision. The cyst was arising from the left postero-lateral wall. The cystic content was drained (15cc). The edges of the cystic wall were trimmed and sutured.
The aspirated fluid cytology showed mixed content of neutrophils, lymphocytes in background of RBC's.
The histopathological evaluation of cyst wall showed flattened to cuboidal epithelium wall. No evidence of granuloma. No evidence of malignancy. Impression: benign cyst.
Case Discussion
Multiple cystic lesions are noted around the vagina. However the three most common vaginal cysts are Gartner duct cyst, Bartholin gland cyst, and Mullerian duct cyst 1. Gartner cyst arises from the upper vagina along the anterolateral wall. Bartholin gland cyst arises from the lower vagina along the posterolateral wall. In our case, the benign cystic lesion was arising from the upper vagina along the posterolateral wall. If the cystic lesions are large, it is difficult to evaluate the site of origin.
Histopathologically, Mullerian duct cysts are lined by mucinous/endometrial or ciliated epithelium. Gartner duct cysts are lined by cuboidal to low columnar epithelium. Bartholin gland cyst are lined by mucinous/transitional to squamous epithelium 2.
Role of MRI is to document size, location and morphology of cyst and its content. Differentiating the different types of vaginal cysts sometimes is difficult and of little clinical importance. Having said that, in our case possibility of Gartner duct cyst was given and histopathology confirms corresponding cuboidal epithelial lining of cyst wall.
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