Nabothian Cysts: The Most Common Benign Cervical Lesion
Nabothian cysts are the most common benign lesions of the cervix, typically occurring in women of reproductive age. 1, 2, 3
Definition and Characteristics
- Nabothian cysts are benign, mucus-filled cysts that form at the squamocolumnar junction of the adult cervix 4
- They develop when squamous metaplasia covers the columnar epithelium of the endocervix, causing blockage of the endocervical glands and subsequent mucus accumulation 3
- These cysts usually occur due to childbirth, minor trauma, or as a natural process in women of reproductive age 1
- They are typically small and asymptomatic, appearing as smooth, dome-shaped elevations on the cervical surface 3
- The cysts contain mucus and can also contain proteinaceous material, neutrophils, or neutrophil debris 4
Clinical Presentation
- Most nabothian cysts are small (a few millimeters) and asymptomatic, discovered incidentally during routine pelvic examination 3
- While generally small, they can occasionally grow larger, with rare cases reaching several centimeters in size 1, 2
- Multiple cysts can occur simultaneously, sometimes giving the cervix a "cobblestone" appearance 3
- Large nabothian cysts are extremely rare but can present with symptoms such as abnormal vaginal discharge, pelvic pain, or a sensation of something protruding from the vagina 1
Diagnosis
- Diagnosis is typically made through visual inspection during pelvic examination 3
- Ultrasonography is valuable for confirming the diagnosis, especially for larger cysts, and can help exclude malignancy 2
- The cysts appear as well-defined anechoic or hypoechoic structures within the cervical tissue on ultrasound 2
- In rare cases where the appearance is atypical or concerning, further evaluation may be necessary to rule out malignancy 5
Differential Diagnosis
- The differential diagnosis for cystic cervical lesions includes:
- Tunnel clusters (deep nabothian cysts)
- Endocervical hyperplasia
- Cystic cervicitis
- Adenocarcinoma
- Adenoma malignum (minimal deviation adenocarcinoma) 5
- It is crucial to differentiate benign from malignant lesions, though imaging characteristics may overlap 5
Management
- Most nabothian cysts require no treatment as they are benign and asymptomatic 3
- For symptomatic large cysts, treatment options include:
- Observation for asymptomatic cases
- Aspiration of cyst fluid
- Surgical excision for very large or symptomatic cysts 1
- Biopsy may be recommended for unusually large cysts or those with atypical features to rule out malignancy 1, 2
Clinical Pitfalls
- The granular content of nabothian cysts may be mistaken for tumor diathesis pattern associated with invasive carcinoma on cytology 4
- Large nabothian cysts can occasionally mimic malignant lesions on imaging and clinical examination 2
- In rare cases, extremely large nabothian cysts can contribute to or unmask underlying pelvic organ prolapse 1