Introduction
Vaginal cysts are rare and diagnosed incidentally, cystic lesion may arise from all the vaginal walls, usually from lateral vaginal walls and rarely may extended into fornix. Depending upon histopathology cyst are classified into squamous inclusion cyst, mesonephric or gartners duct cyst, mullerian or paramesonephric cyst, bartholian cyst.1, 2 The cyst may present with different sign and variety of symptoms. Here we are presenting a rare case report of anterior vaginal wall cyst.
Case Report
A patient of 35 years old woman presented to OPD with complaining of mass per vaginum since 6yrs, white discharge per vaginum since 6yrs, difficulty in micturation since 6 months, dyspareunia sine 3months. Patient had no previous medical disorders and surgical operations. attain menarche at the age of 13 yrs, with regular menstrual cycle and LMP 45 days back, she is para 3 living 3, with marital life 15 yrs, and her last child birth 8 yrs back.
On General physical examination vitals signs are normal, cardiac and respiratory system is normal. On per abdomen examination –abdomen is soft, non tender, no palpable mass is palpated. On per speculum examination-white discharge is seen, uterine prolapse is seen.
On per vaginal examination-UV prolapse of 2nd degree is noted, with a cyst of size 5*4cm is palpated at left anterior and left lateral wall of the vagina at the level of mid vagina, which is cystic in nature and non tender.
Diagnosis
Second degree UV prolapse with cervisitis with cystocele and rectocele with anterior vaginal wall cyst.
Management
All the investigation of the patients are with in normal limit and posted for surgery vaginal hysterectomy with urethrocele and rectocele repair with cyst excision.
Intra operative-on dissection of cyst- thick, chocolate colour mucinous secretions are seen.
There are no post-operative complications.
Discussion & Conclusion
Most of the vaginal cyst are asymptomatic and treatment is not needed prevalence is 1 in 2003 patient may complain of mass per vaginum, vaginal discomfort, dysparunia, vaginal pain. The vaginal wall cyst should be differentiated from cystocoele and rectocoele by examination location of the cyst excludes from bartholian cyst endometriotic cyst should be ruled out by absence of cyclical abdominal pain during menstrual cycle.
Mullariancyst are the most common cyst seen in the vaginal wall, mostly they are located anteriolaterally, usually single sometimes multifocal.4, 5 During embryonic development paramesonephric duct (mullarian duct) fuses distally and forms uterus, cervix and upper part of vagina, these are lined by pseudostratified coloumar epithelium mesonephric duct (wolffian duct) regress in females the derivaties of these ducts seen with in the vaginal walls.
Gartners cyst is lesscommon, most common;y sen anteriolateral vaginal walls and it is associated with abnormalites of metanephricduct like ectopic ureter, unilateral ureter and renal hypoplasia.6, 7
Gartners cyst contain basement membrane and smooth muscle layer. Clear distinguish from mesonephric and paramesonephric duct by histo chemical staining paramesonephric cyst mucin and periodic acid schiff positive, mesonephric duct are devoid of they are negative.6
Transvaginal ultrasound and magnetic resonance imaging is done to see exact location, number and its extension,8 MRI is imaging modality of choice to know characteristic of the tumour6 treatment includes surgical excision of the cyst it may include incision and drainage or marsupilization of the cyst, during surgery injury should be avoided to urethra and bladder usage of laser reduces complication like post-operative pain, dyspareunia and hemorrhage.
This is a rare case of benign muscinous cyst of anterior vaginal wall.
