The Atypical Vaginal Wall Cysts

Vaginal wall cysts have been cited principally in women in their child bearing age. However, these have been additionally noted in infanthood, children and post menopausal women. The cited occurrence is one in two hundred. Certain reassessments detected epithelial cysts to be the widely prevalent vaginal cysts while there were others that cited mullerial cysts. Though they could crop up anywhere, however they are normally seen in the anterolateral vaginal wall.

Their size is noted to be varying between 1.4cms – 7cms. On rare occasions a symptomatic congenital cyst could be even bigger than the range just specified. Cysts that appear at the level of the cervix normally enlarge anteriorly lying in relation to the bladder and may present as cystocele. Hardly ever a large sized mullerian cyst might present as anterior enterocele. In some rare cases, the cyst may present as posterolateral wall. Additionally, the comparatively rare occurrence of daughter cyst that is totally reducible within the parent cyst is noted.

The rather atypical and mostly a secondary detection, the vaginal cysts have been categorised on the basis of the histology of their lining as epithelial inclusion, mullerian, mesonephric and urothelial in addition to other uncommon forms. Mullerian cysts might be symptomatic at times presenting as a noticeable or conspicuous mass, dyspareunia, voiding problem, vaginal discharge and pain.

Those women that suffer from this rare vaginal cyst experience problems during pregnancy due to a mass prolapsing through the introitus. The mass is noted to increase in size on straining and is totally reducible. The size of the mass however remains constant over time with no associated bowel or bladder problems.

Such women undergo caesarean section as the vaginal mass was expected to cause hindrance to delivery. In such women, the general and abdominal exams were normal. The presence of a 5 x 5 centimetres tense cystic swelling encased by vaginal mucosa is seen at the introitus in these women. Transvaginal sonography revealed normal uterus and ovaries. A computed tomography scan shows the presence of hypodense lesion of fluid intensity noted in the region of the vagina projecting through the introitus and expanding to posterior fornix with the appearance of internal septation and without any mural nodule or contrast enhancement. Though, rectum appears normal.

Such patients are taken up for surgical excision of the cyst under anesthesia. During the operation, the cyst wall is stripped away from the vaginal wall and the cyst removed in toto.

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