Anna Trikhacheva MD , Katherine Dengler MD , Tricia A. Murdock MD , Daniel Gruber MD
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引用次数: 0
Abstract
Objective
The objective of this video is to review a case of a patient that presented to urogynecology clinic for prolapse but was noted to have anterior vaginal cyst. In this video, we review differential diagnosis, embryologic origin of vaginal cyst, excision procedure, imaging, and pathology of the vaginal cyst.
Setting
Urogynecology clinic/operating room
Participant
Patient who presented with anterior vaginal cyst
Intervention
Thirty-four-year-old G0 referred to Urogynecology for a vaginal bulge. On exam, she had a 4 cm anterior vaginal cystic mass. The differential diagnosis for benign vaginal cysts is broad, including Müllerian or Gartner's (mesonephric) ducts, Skene duct, Bartholin gland, epidermal inclusion, or endometriotic cysts, adenosis, or urethral diverticulum [1,2]. Most are secondary to embryological remnants or trauma [3].
Müllerian ducts form the fallopian tubes, broad ligament, uterus, cervix, and upper part of the vagina. Müllerian epithelium is replaced with squamous epithelium of the urogenital sinus; however, Müllerian epithelium can persist anywhere along the vaginal wall. Thus, Müllerian cysts can be found at any location in the vagina [4].
During vaginal cyst work-up, imaging can be helpful to further differentiate the cyst and aid in surgical planning. Our patient had an in-office translabial ultrasound that revealed a fluid-filled vaginal cyst that had possible bladder connection. Pelvic Magnetic Resonance Imaging showed a 4 cm non-communicating fluid-filled cyst that was abutting the bladder in its entirety. We present imaging and a surgical excision video demonstrating the importance of meticulous dissection directly on the bladder wall. The video also presents histopathology slides with bland, endocervical-type columnar epithelium, leading to the final diagnosis of a Müllerian duct cyst.
Conclusion
Vaginal cysts require careful examination and imaging. Understanding their location is crucial for surgical planning, counseling, and successful patient outcomes.
Video Abstract
Download: Download high-res image (59KB)
Download: Download full-size image (7KB)
Video. Video. Relapsed vaginal sarcoma successfully treated with anterior pelvic exenteration through a minimally invasive approach combining robotic and vaginal surgery and subsequent multilayer pelvic reconstruction.
期刊介绍:
The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.