Nabothian Cyst (Follicle Nabothian)

Ovula nabothi[1]

The nabothian cyst contains mucus and often appears like a tiny swelling on the anterior surface of the cervix. The size of nabothian cyst may vary from 2-40 mm. The color of the mucus is also variable ranging from clear, yellow to a greenish yellow.

Nabothian Cyst develops due to the following process: anatomic/foreign.

Presentation

Nabothian cysts are generally first identified by gynecologists during a pelvic exam. They rarely cause symptoms unless they are large. The majority of women with a nabothian cysts do not even known they have such a cyst as there are no symptoms. These lesions often appear as tiny cyst or vesicle on the anterior surface of the cervix. The nabothian cyst may be single, a collection of cysts in a cluster or a large complex multiloculated cyst. The color may vary from reddish white and a fluid (mucus) may be visible inside the cyst. Only in rare cases where the cyst is large, symptoms develop. Anecdotal case reports indicate that the symptoms from a large nabothian cyst may include vaginal bleeding, vague pelvis discomfort or a pressure like sensation. Sometimes a large nabothian cyst may obstruct the cervical orifice and lead to lower abdominal discomfort, especially during the menstruation.

Skin
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  • urogenital
    Cervical Cyst
    • Cervical cysts usually are discovered incidentally while a woman examines herself or by the doctor during a pelvic exam.[babymed.com]
    • Nabothian cyst Symptoms The cervical cyst does not produce any symptoms and majority of female patients are unaware of this condition.[patienthelp.org]
    • Cervical cysts are mucous-filled lumps that form on the cervix and are rarely cancerous.[popsugar.com]
    Vaginal Discharge
    • All conditions which increase vaginal discharge may predispose to nabothian cyst formation.[medicotips.com]
    • Most cases of cervicitis are unnoticed by the patient, but some notice painful intercourse, persistent vaginal discharge, aching pelvic pain or menstrual cramps.[brooksidepress.org]
    • However, larger cysts can block the cervical opening and cause irregular bleeding as well as vaginal discharge.[patienthelp.org]
    • These cysts are usually asymptomatic but in case if a female experiences abnormal vaginal bleeding not due to menstrual periods, pelvic pain, or vaginal discharge then it may indicate some sort of infection which may need medical attention and hence it[epainassist.com]
    Urinary Retention
    • Very large cysts have secondary symptoms (such as pressure, heaviness, or urinary retention) unlike the absence of symptoms that characterizes the majority of nabothian cysts.[glowm.com]
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  • Eyes
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  • psychiatrical
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  • respiratoric
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  • neurologic
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  • Face, Head & Neck
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  • Entire body system
    Chronic Infection
    • ICD-9-CM Volume 2 Index entries containing back-references to 616.0 : Abscess (acute) (chronic) (infectional) (lymphangitic) (metastatic) (multiple) (pyogenic) (septic) (with lymphangitis) (see also Cellulitis) 682.9 cervix (stump) (uteri) (see also Cervicitis[icd9data.com]
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  • Workup

    There is no blood test that is diagnostic of a nabothian cyst. If a nabothian cyst is suspected, one may order a pelvic ultrasound. However, a transabdominal ultrasound is not very sensitive and is likely to miss small cysts. A transvaginal ultrasound performed by a radiologist or an obstetrician is more sensitive for a nabothian cyst. However, cysts smaller than 1 cm can be missed.

    Colposcopy may help differentiate whether the lesion is benign or malignant. Any suspicious areas are usually biopsied and analyzed by the pathologist for presence of malignant cells [4] [5].

    Pelvic MRI may be used to look for nabothian cysts, which may appears as either localized cystic swellings or multiloculated cystic lesions within the superficial layers of the cervix. This method is not the test of first choice and often only done when the patient is symptomatic and the diagnosis of a nabothian cyst is not made with any other means. CT scan can be used to detect nabothian cysts but small cysts may be missed [6] [7] [8].

    Pathology

    Biopsy
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  • Test Results

    Colonoscopy
    Polyps
    • See also [ edit ] Cyst Polyp (medicine) References [ edit ] External links [ edit ] 00501 at CHORUS Histology at ttuhsc.edu[en.wikipedia.org]
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  • Treatment

    The majority of nabothian cysts are discovered incidentally and are asymptomatic. Most require no treatment. The cysts are benign and have no malignant potential. If the cyst is large, there are several options for treatment [9]. Aspiration of the mucus fluid can be attempted but recurrence rate is high. For large cysts that are causing symptoms a formal surgical excision may be required. The surgery may be done under spinal or regional anesthesia and good access to the anterior cervix is required. Surgery is sometimes done when the cyst appears multiloculated and there is a need to confirm the presence of absence of a malignancy. Since nabothian cysts are not very deep, superficial excision may be adequate. There are isolated reports of use of laser, electrocautery or liquid nitrogen to treat the cyst. Sometimes multiple treatment sessions are required to completely eradicate the cysts. There are not enough data on how common recurrences are after treatment.

    Prognosis

    The prognosis is excellent for all sizes of nabothian cysts. While they do not resolve spontaneously, they generally do not cause any symptoms.

    Complications

    Cervical Cancer
    • Cervical Cancer Pap smear screening has had a dramatic impact on the incidence of cervical cancer.[brooksidepress.org]
    • They in no way predispose a female to cervical cancer.[epainassist.com]
    • Also, the abnormal bleeding is a sign of cervical cancer.[medhelp.org]
    • Ihope someone could answer me. im really bothered and i dont wanna have cervical cancer someday[inspire.com]
    • If the cyst size is more than 8 cm in diameter, then it has similar symptoms like cervical cancer or uterine tumor.[medicalfoxx.com]
    Infection
    • , infected, infective (opportunistic) 136.9 cervix (see also Cervicitis) 616.0 endocervix (see also Cervicitis) 616.0 Inflammation, inflamed, inflammatory (with exudation) cervix (uteri) (see also Cervicitis) 616.0 Irritation cervix (see also Cervicitis[icd9data.com]
    • Cervicitis Cervicitis means an infection of the cervix.[brooksidepress.org]
    • The doctor didn't specify the type of cyst either, just that it appeared to be infected.[aapc.com]
    • In the context of infertility treatments, cervical stenosis may complicate or prevent the use of intrauterine insemination Cervicitis · Cervical polyp · Nabothian cyst 15female Genital System Infection Glands caused by obstruction of the gland orifices[homeremedytreatments.com]
    • ] Rarely, nabothian cysts have a correlation with chronic cervicitis, an inflammatory infection of the cervix.[en.wikipedia.org]
    Epithelial Cyst
    • Nabothian cysts are also known as mucinous retention cysts or epithelial cysts , and are benign features of the adult cervix, with multiple cysts possibly appearing at any given time.[allthingsvagina.com]
    • These cysts are also known by the name of Mucinous Retention Cyst and Epithelial Cyst.[epainassist.com]
    • Sometimes the tiny bumps are called cervical cysts , mucinous retention cysts, or epithelial cysts.[healthline.com]

    Etiology

    Nabothian cysts are not commonly seen in young girls or in females who have not given birth. These cysts often arise after the birth of a child or a result of surgery (hysterectomy). The new cell lining that grows over the cervix sometimes blocks the ducts of the nabothian glands, which lie near the surface of the cervix. Once the opening of the nabothian gland is blocked, a small cystic structure develops. The mucus secreted by the nabothian gland cannot be discharge in the surface of the cervix and consequently a swelling is the result.

    Causes

    Epidemiology

    The exact number of women with nabothian cysts is unknown because many women have no symptoms. In addition, unless a physical exam of the pelvis is done, these cysts are often not visible. Radiology reports indicate that nabothian cysts are common and may be seen in 12% of women who undergo imaging studies of the pelvis for another cause. Nabothian cuts occur in women of all races and are most common in women who have given birth. Nabothian cysts may also be seen in post-menopausal women who have a decrease in estrogen and a consequent thinning of the cervix. In rare cases, a nabothian cyst may develop in women with chronic cervicitis.

    Sex distribution
    Age distribution

    Pathophysiology

    Nabothian cysts occur as a result of healing after normal healing or traumatic injury to the superficial lining of the cervix. For example during birth, there is always some loss of superficial cells of the cervix. During healing the new cells plug up the ducts from the nabothian gland, which leads to retention of the mucus secretion and development of cysts.
    Sometimes nabothian cysts may occur as a delayed complication of a hysterectomy. The transformation layer of the cervix is internalized and this results in obliteration of the ducts of the nabothian glands, which eventually results in development of cysts.
    The majority of nabothian cysts range from 2-10 mm in diameter but there are some rare women who may develop cyst that are the size of a grape or about 4-6 cm.
    When the ducts of the nabothian gland are close to each other, one can even see a cluster of nabothian cysts. Microscopy usually reveals multicystic dilatation of the gland.
    When a cystic structure appears on the cervix, the differential diagnosis includes the following:
    - Adenoma malignum
    - Adenocarcinoma of the cervix
    - Bartholin gland cyst

    Prevention

    There is no way to prevent a nabothian cyst. Most are incidental and the cause is iatrogenic.

    Summary

    A nabothian cyst is also known as retention cyst, mucus retention cyst, nabothian follicle or an epithelial inclusion cyst. These non-neoplastic cystic structures appear as tiny bumps on the anterior surface of the cervix. Nabothian cysts occur when the superficial layer of the cervix gets traumatized or is erased and the growth of the new layer closes of the opening of the nabothian glands underneath. The progressive accumulation of mucus leads to cystic enlargement and a bump on the cervix. Nabothian cysts are commonly found in women of child bearing age and vary in color from yellow to whitish red. They are not tender and the majority produce no symptoms. Even though most nabothian cysts cause no symptoms, some may enlarge over time. Nabothian cysts are benign cystic lesions but often need to be differentiated from other malignant lesions that also occur on the cervix [1][2] [3].

    Patient Information

    A nabothian cyst, also known as a retention cysts of the cervix, is a tiny lump on the surface of the cervix, the lower part of the uterus. It is filled with mucous and usually harmless. Because the cause of nabothian cysts is not known there is no way of preventing them. However, once a nabothian cyst is diagnosed, the patient should be assured that the lesion is benign and does not cause symptoms in most cases

    Other symptoms

    Cervicitis
    • This tissue growth can block the cervical crypts (subdermal pockets usually 2–10 mm in diameter), trapping cervical mucus inside the crypts.[en.wikipedia.org]
    • Endocervicitis (see also Cervicitis) 616.0 due to hyperplastic 616.0 Endometritis (nonspecific) (purulent) (septic) (suppurative) 615.9 cervix, cervical (see also Cervicitis) 616.0 Endotrachelitis (see also Cervicitis) 616.0 Erosion Eversion Follicle[icd9data.com]
    • Nabothian Cysts Cervical Ectropion Cervicitis Condyloma Dysplasia Cervical Cancer The opening of the uterus is called the cervix.[brooksidepress.org]
    • Known As Nabothian cyst is also known as atrophy of cervix, bleeding cervix, cervical annular detachment, cervical effacement 30%, cervical effacement 40%, cervical effacement 50%, cervical effacement 60%, cervical excitation absent, cervical lesion,[healthresearchfunding.org]
    • Constant accumulation of mucus transforms the cervical crypts into a cyst.[patienthelp.org]
    Chronic Cervicitis
    • ] Rarely, nabothian cysts have a correlation with chronic cervicitis, an inflammatory infection of the cervix.[en.wikipedia.org]
    • Chronic cervicitis, STD's are something to think about.[healthcaremagic.com]
    • Nabothian cysts are usually associated with chronic cervicitis, an inflammatory condition of cervix, and are harmless and usually disappear on their own.[scopemed.org]
    • Less often, nabothian cysts are related to chronic cervicitis, a long-term infection of the cervix.[health.harvard.edu]
    • Definition / general A normal finding; no treatment needed Due to obstruction of crypt openings containing mucus by squamous epithelium, causing acute and chronic cervicitis; also form after subtotal hysterectomy due to ablation of cervical canal ( J[pathologyoutlines.com]
    Pelvic Examination
    • This is a common finding in Routine Pelvic Examination in women of reproductive age .[medilinks.blogspot.com]
    • Diagnosis A gynecologist can usually diagnose the cysts during a pelvic examination by looking for mucus filled glands on the cervix.[justanswer.com]
    • They can be easily identified during a routine pelvic examination.[epainassist.com]
    • Your doctor may notice one or more cysts during a routine pelvic examination .[healthline.com]
    • However, it is advisable for a woman to visit her gynecologist for regular checkups, as these cysts are normally detected during routine pelvic examinations.[primehealthchannel.com]
    Menstruation
    • But sometime, a large nabothian cyst may block the cervical opening and cause discomfort during menstruation.[medicotips.com]
    • However, often when the cysts become large, they can cause pain during menstruation as well as cause an abnormal discharge.[justanswer.com]
    • He said they tend to get bigger towards the end of our cycle and then when we do start menstruation they tend to shrink back down.[nomorepanic.co.uk]
    • Normally, your cervix is open to allow your menstruation fluid to pass from your uterus to your vagina , and for sperm to enter the uterus from the vagina.[healthline.com]
    Very Rare
    • Very rarely nabothian cyst needs hysterectomy as in our case.[scopemed.org]
    • T1 iso to hypointense relative to muscle in typical cases very rare cases with mucin may show some high signal T2: cysts are hyperintense relative to muscle T1 C (Gd): there is no associated enhancement Treatment and prognosis Most Nabothian cysts are[radiopaedia.org]
    • Majority of the cases of Nabothian Cysts do not need any treatment, although very rarely the size of the cyst may be quite large and may affect the size and shape of the cervix to an extent that it may be difficult for a physician to inspect the cervix[epainassist.com]
    • The cysts generally go away automatically and in some very rare cases do they pose as a persistent threat.[primehealthchannel.com]
    • This condition, called adenoma malignum, is very rare and is not a cause for concern.[healthline.com]
    Diaphragmitis
    • Nabothian cyst Diagnosis A large percentage of diagnosed cervical cysts are detected by women who feel or observe a lump when inserting a diaphragm or cervical cap, a form of barrier contraception.[patienthelp.org]
    • The woman may also notice the cyst herself while inserting a cervical cap or a diaphragm, or when going through a cervix check up.[primehealthchannel.com]
    Metastasis
    • […] history of any malignancy, particularly those that are prone to metastases, including breast, melanoma, gestational trophoblastic disease, and high-grade malignancies of the gastrointestinal tract or lung, may be a clue that this lesion represents a rare metastasis[glowm.com]
    Intermediate
    • 20-08-15, 09:52 Intermediate Member Join Date: Dec 2014 Posts: 693 Cervix worries - nabothian cyst got bigger Hi A few months ago during an examination the nurse said I have a nabothian cyst on my cervix.[nomorepanic.co.uk]
    Lidocaine
    • A Graves speculum was then introduced into the vagina and 1% lidocaine was then injected into the cervical cyst.[aapc.com]

    Self-assessment

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    References

    1. Tran TA, Niu G, Tomasello CA, Tran HV, Ross JS, Carlson JA. The spectrum of grossly visible pigmented lesions in the uterine cervix: a prospective study. Int J Gynecol Pathol. 2014 Jan;33(1):89-99.
    2. Temur I, Ulker K, Sulu B, Karaca M, Aydin A, Gurcu B. A giant cervical nabothian cyst compressing the rectum, differential diagnosis and literature review. Clin Exp Obstet Gynecol. 2011;38(3):276-9.
    3. Liu S, Zhang M, Qu Y, Pan Y, Zhang Y. Increased iodine uptake in the Nabothian cyst. Clin Nucl Med. 2013 Feb;38(2):157-8
    4. Casey PM, Long ME, Marnach ML. Abnormal cervical appearance: what to do, when to worry? Mayo Clin Proc. 2011 Feb;86(2):147-50;
    5. Bin Park S, Lee JH, Lee YH, Song MJ, Choi HJ. Multilocular cystic lesions in the uterine cervix: broad spectrum of imaging features and pathologic correlation. AJR Am J Roentgenol. 2010 Aug;195(2):517-23
    6. Sosnovski V, Barenboim R, Cohen HI, Bornstein J. Complex Nabothian cysts: a diagnostic dilemma. Arch Gynecol Obstet. 2009 May;279(5):759-61.
    7. Okamoto Y, Tanaka YO, Nishida M, Tsunoda H, Yoshikawa H, Itai Y. MR imaging of the uterine cervix: imaging-pathologic correlation. Radiographics. 2003 Mar-Apr;23(2):425-45; quiz 534-5.
    8. Oguri H, Maeda N, Izumiya C, Kusume T, Yamamoto Y, Fukaya T. MRI of endocervical glandular disorders: three cases of a deep nabothian cyst and three cases of a minimal-deviation adenocarcinoma. Magn Reson Imaging. 2004 Nov;22(9):1333-7.
    9. Young RH, Clement PB. Pseudoneoplastic glandular lesions of the uterine cervix. Semin Diagn Pathol. 1991 Nov;8(4):234-49.

    • Adenoma malignum: MR appearances mimicking nabothian cysts. - Y Yamashita, M Takahashi - American Journal of , 1994 - Am Roentgen Ray Soc
    • A practical manual on visual screening for cervical neoplasia - R Sankaranarayanan, RS Wesley - 2003 - books.google.com
    • A comparative analysis of cross sectional imaging techniques in minimal deviation adenocarcinoma of the uterine cervix - K Itoh, T Toki, S Shiohara, O Oguchi - Journal of Obstetrics , 2005 - Wiley Online Library
    • Adenoma malignum: MR appearances mimicking nabothian cysts. - Y Yamashita, M Takahashi - American Journal of , 1994 - Am Roentgen Ray Soc


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    1. Ovula nabothi, CC BY-SA 2.0

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