Cervical cyst is a non–tumor or tumor formation that represents a cavity with liquid or fat-like contents. The symptoms of the disease vary from the complete absence of visible manifestations to an increase in the volume of mucous discharge from the genital tract, contact bleeding, menstrual disorders. The diagnosis is based on anamnestic data, the results of gynecological examination using colposcopy and cervicoscopy, morphological examination. Both medical and surgical treatment is used.
ICD 10
N88.8 Other specified non-inflammatory diseases of the cervix
General information
Cervical cyst is a cavity formation in the area of the cervical canal or exocervix, filled with mucous, serous, bloody contents or a thick mass with elements of ectoderm derivatives. The size of the cystic cavities ranges from a few millimeters to several centimeters. The color depends on the origin of the cyst, it can be pink, chocolate, bluish or yellowish. The disease is usually registered in women of reproductive age. The incidence of pathology is 15-25%. Formations, as a rule, are not prone to malignancy.
Causes
The cause of the development of non–tumor cysts is a violation of the outflow of fluid from the natural or pathological cavity structures of the organ – pseudogelesis (crypts) formed by folds of the cylindrical epithelium, foci of endometriosis, remnants of mesonephros. The formation of cystic cavities has a polyethological nature. The most significant risk factors include:
- Cervical injuries. They are usually associated with childbirth (multiple, large fetus, with the use of obstetric aids), abortions, therapeutic and diagnostic manipulations (requiring dilation of the cervix, ablative treatment of its pathologies, hysterosalpingography). Endometrial cells are easily implanted into damaged tissues. Posttraumatic ectropion is very often combined with multiple nabotovye cysts.
- Endocrine disorders. As a result of hypothalamic-pituitary disorders, ovarian hypofunction, adrenal hyperandrogenism, relative hyperestrogenism develops. This increases the viability of endometrial cells implanted on the cervix, creates favorable conditions for the persistence of cervical ectopia with the formation of retention cystic formations.
- Immune disorders. The development of pathology is often a consequence of T-cell immunodeficiency and simultaneous autoimmunization, changes in the microbiocenosis of the vagina. Violation of the local immune status is often associated with the widespread and not always rational use of antibacterial drugs for the rehabilitation of the lower genital tract.
- Inflammatory diseases. Purulent-inflammatory diseases of the genitals (cervicitis, colpitis, adnexitis) lead to an imbalance of humoral and cellular immunity, which leads to the development of cervical ectopia, endometriosis and, as a consequence, the formation of cystic cavities. In addition, the inflammatory process contributes to the blockage of crypts due to tissue edema, mucus hypersecretion, and epithelial exfoliation.
Pathogenesis
Cervical cyst have different origins, can be formed both from normal organ tissues and from ectopic, rudimentary remnants, germ cells. A small part of the formations is caused by the accumulation of fluid in the rudiments of the mesonephral ducts located deep in the stroma of the organ, or by the growth of the population of germinogenic cells.
Squamous metaplasia is the basis for the formation of the most common – nabot cysts. The replacement of the cylindrical mucus-producing epithelium with a protective (multilayer squamous) one often leads to the overlap of the cervical “glands” (crypts) and their cystic expansion. In the vast majority of cases, this process occurs in ectopic areas, but sometimes it is noted in the cervical canal or on the surface of the polyp.
The formation of another common type of pseudotumors is associated with endometrial ectopia. In this case, the cavity is formed not from normal cervical tissue, but from structures morphologically and functionally similar to the inner lining of the uterine body implanted in the cervical region. The result of cyclic hormonal changes is a monthly rejection of the epithelium, similar to that in the body of the uterus, inside endometrioid foci, as well as the accumulation of bloody fluid in them with the formation of cystic cavities.
Classification
The vast majority of cervical cysts (with the exception of dermoid) belong to tumor-like (pseudo-tumor) processes. Cysts can be multiple or single, by localization – para- or endocervical, located respectively on the vaginal portion of the cervix and in its channel. The definition of the type of education is necessary for the choice of treatment tactics. Taking into account the origin of cervical cystic formations , there are:
- Nabothian cysts. They make up the majority of cystic pathologies of the cervix. Their growth is caused by obstruction of the cervical “glands”. The formations have a retention character, are more often localized on the ectocervix, are represented by stretched glands filled with their own mucous secret, sometimes with an admixture of blood.
- Endometrioid cysts. They are a consequence of cervical endometriosis, do not belong to tumor processes. Formed by sections of the ectopic endometrium with cavities filled with bloody fluid. Isolated endometriosis of this localization is usually associated with trauma.
- Embryonic cysts. They are extremely rare, they belong to true (retention) cystic formations. They are remnants of mesonephral channels filled with serous fluid. They may be congenital or formed as a result of cervical injuries.
- Dermoid and epidermoid cysts. Rarely occurring embryonic tumor formations are mature cystic tecomas that have a benign character. Histologically, they include the epidermis with or without appendages. Often, traumatic effects lead to the growth of such neoplasias.
Symptoms
Cervical cyst for the most part have no visible signs and are detected accidentally during a gynecological examination. With large or multiple nabotohine cysts, dyspareunia may be noted, their rupture is manifested by an increased volume of mucous whites. With endometrioid cysts before and after menstruation, minor spotting, contact bleeding, sometimes menorrhagia, menometrorrhagia may be observed.
Large embryonic cysts displace the urinary tract, which causes difficulty urinating or incontinence. Uncomplicated cervical cysts are often not accompanied by pain syndrome. Pain is observed in the case of suppuration of cystic formations. With cervical endometriosis, pain is noted in the case of combination with endometriosis of other localizations.
Complications
Large and multiple untreated pathological formations, changing the architectonics of the cervix, can lead to infertility, miscarriage, and be an obstacle to childbirth through the natural birth canal. Infection of an embryonic cyst is accompanied by its suppuration. This condition requires immediate surgical intervention, otherwise severe complications may develop – pelvioperitonitis, parametritis, sepsis.
Nabothian cysts are often a reservoir for pathological microorganisms (more often chlamydia, mycoplasma, gonococci), which entails a chronic course of gynecological infections, their frequent relapses. This leads to persistent ectopia of the cylindrical epithelium, as a result of which new cystic enlarged glands are formed, the risk of precancerous and cancerous pathologies increases. Cervical cyst themselves usually do not malignate, but the reasons that provoked their appearance increase the risk of cancer.
Diagnostics
Diagnosis of cervical cyst is carried out by a gynecologist. Cervical cyst located on the vaginal part of the uterus can be detected visually without much difficulty by non-invasive methods. Formations localized supravaginally require a more complex study. Hardware and laboratory methods used in the diagnosis of cervical pathologies include:
- Endoscopic examination. Colposcopy with a sample of acetic acid and a Schiller sample allows you to identify a tumor-like process in the area of the external pharynx. With the help of cervicoscopy, cystic cavities are detected in the cervical canal, and a biopsy is taken if necessary. Cervicoscopy is used if the junction zone of two types of epithelium is located in the endocervix or there is a suspicion of endocervical neoplasia.
- Ultrasonography. Transvaginal ultrasound with Doppler imaging visualizes formations localized in the area of the endocervix and in the thickness of the cervical wall – embryonic and dermoid cysts. According to ultrasound signs, it is possible to assume a benign or malignant nature of neoplasia.
- Morphological examination. It is carried out to verify the diagnosis. Both cytological examination and more accurate histological examination are used. The techniques help to definitively determine the type of formation (for example, it is visually difficult to distinguish a hemorrhagic nabotov cyst from an endometrioid cyst), to differentiate it with malignant neoplasia.
If necessary, a culture and PCR analysis of the vaginal smear and the contents of the punctate of the nabot cyst is performed to detect infection (including hidden ones). To determine the causes of pathology, hormonal analysis, an immunogram, consultations with an endocrinologist, an immunologist can be prescribed. Differential diagnosis is carried out primarily with invasive cervical carcinoma, which may require consulting an oncogynecologist.
Treatment
With an asymptomatic course and no complications (combination with infection, background or precancerous pathology, violation of the architectonics of the cervix), the patient is recommended dynamic monitoring, correction of menstrual function. Some clinicians prefer to remove even uncomplicated nabotovian cysts in order to eliminate a potential source of infection, but such tactics remain a subject of debate.
Complicated and recurrent forms require complex treatment. Cystic formations are removed, inflammation is treated before destruction, and functional disorders are corrected after. Therapeutic measures are aimed at preventing ascending infection and purulent-septic complications, reproductive dysfunction, the development of precancerous conditions and malignant tumors.
Conservative therapy
The goals of conservative treatment are the elimination of a specific infection, normalization of vaginal biocenosis, elimination of endocrine and immune disorders. Restoration of immune and hormonal homeostasis can lead to spontaneous resolution of endometrioid and nabotovye cysts. Treatment is prescribed individually depending on the results of the examination.
- Infection therapy. For the treatment of colpitis and cervicitis, combined antibacterial and antifungal drugs, antiseptics are applied topically. After laboratory determination of the causative agent of infection, specific medications are used internally or externally. Physiotherapy is used (low-frequency ultraphonophoresis of antiseptics, laser therapy).
- Correction of immune-hormonal disorders. To normalize menstrual function, multiphase estrogen-gestagenic oral contraceptives are usually prescribed, with severe disorders (anovulation, luteal phase insufficiency) – low-dose monophasic drugs. Systemic immunomodulatory therapy includes immunomodulators, adaptogens (tinctures of lemongrass, ginseng)
Surgical treatment
Surgical treatment of cervical cyst is indicated for suppurated, large formations that worsen the quality of life and hinder the realization of reproductive function, or after a reliable assessment of the state of the cervix in the case of precancerous changes. Both non-surgical and operative methods can be used. The choice depends on the nature of the lesion, the patient’s desire to have children in the future.
- Ablative methods. In young women, minimally invasive methods – cryodestruction, laser and radiofrequency ablation – are used for the treatment of uncomplicated nabote and endometrioid cysts. In case of nabotovye cysts, the cavity is pre-emptied with a needle. Endometrioid cysts are either vaporized or excised with subsequent cryodestruction.
- Surgical operation. Patients in pre- or postmenopausal women who do not want to have children, with a complicated cyst (in combination with dysplasia, with deformity of the cervix) perform a cone-shaped amputation of the cervix. Such intervention minimizes the likelihood of relapse. With embryonic cysts, cystic tecomas, the formation is hatched with a capsule.
Prognosis and prevention
The prognosis for cystic formations of the cervix is favorable, uncomplicated forms usually do not cause the patient anxiety, do not interfere with sexual life and childbirth. After surgical treatment of endometrioid, nabotovye cysts, the percentage of relapses is quite high. This is due to the fact that it is not always possible to completely eliminate the violations against which the pathology has developed.
Prevention of cervical cyst consists in the rational management of childbirth, the fight against abortion, timely treatment of inflammatory gynecological pathologies, immune and endocrine disorders. In uncomplicated forms, preventive examinations, including colposcopy and bacteriological analysis, are carried out once a year. Patients after destructive treatment with complicated cysts need more careful monitoring.
