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Vulvovaginal cysts are a common problem for women, causing significant pain, discomfort and impact on quality of life. For clinicians, classifying and differentiating these cysts from each other and selecting appropriate management can be challenging, yet there is no integrated classification system and little literature that broadly summarises a clinical approach. We aimed to create a useful tool for clinicians by providing a detailed summary of various vulvovaginal cysts and abscesses with a clear novel classification system and hierarchy for diagnosis and management, to aid clinicians in this process., (© 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Vaginal cysts are a common finding. The differential diagnosis includes epidermal inclusion, Bartholin gland, Gartner duct, and Skene gland cysts and Müllerian anomalies. Rarely, leiomyomas, cancers, or ectopic ureters or megaureters are found., Case: A 31-year-old woman, gravida 3 para 3, presented with a 12-year history of intermittent abdominal pain and involuntary loss of urine. She was diagnosed with ectopic vaginal megaureter after evaluation and subsequently underwent a nephroureterectomy with a marsupialized distal ureter. She remains asymptomatic., Conclusion: Consideration of a rare diagnosis such as an ectopic ureter is important when patients repeatedly present with involuntary urinary incontinence in conjunction with a vaginal cyst and an otherwise negative evaluation. Using magnetic resonance imaging can be useful to assess urinary tract involvement, particularly in patients with known urinary tract malformations.

During a routine physical examination of a term, healthy neonate of Somalian origin we observed an anteriorly located interlabial yellow cyst with visible vascularisation on the outer surface. It caused lateralisation of the urinary meatus without notable obstruction. A Skene's duct cyst, or paraurethral cyst, was clinically diagnosed with spontaneous regression. This is a self-limiting phenomenon of unknown origin that rarely requires surgical drainage in case of urinary obstruction.

Background: Gartner duct cysts represent vestigial remnants of the caudal end of the mesonephric (Wolffian) ducts. They are often associated with ureteral and renal abnormalities. In most cases they are solitary, less than 2 cm in diameter. Giant Gartner duct cysts are extremely rare., Case: We present a girl with a giant Gartner duct cyst, without notable associated abnormalities or pathology, successfully treated by surgical excision. Preoperative aspiration revealed elevated level of CA-125 in the cyst fluid, with normal serum level of the same marker., Conclusion: Analyzing the aspirated fluid for CA-125 may be a useful tool for evaluation of cystic lesions in this region., (Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.)

During the physical examination of a full-term neonate we noticed a stalked, fluid-filled appendix, attached to the posterior vagina wall. A 'hymenal tag' was diagnosed: an innocent, self-limiting phenomenon caused by maternal oestrogens.

Gartner cyst is usually an asymptomatic vaginal cyst, measuring less than 2 cm, frequently found during a routine gynaecological examination. Very rarely, as these cysts are closed structures, they may increase in size because of mucus production. We describe here a case of a large Gartner cyst of approximately 8 cm, its differential diagnosis, investigation and vaginal surgical approach (with illustrations), that progressed uneventfully.

Patients with a vaginal mass (large Bartholin's duct cyst) associated with a contralateral renal cyst and hydroureteronephrosis are unable to urinate. While occasionally seen in adults, Bartholin's duct cyst is rare in neonates. The origins of Bartholin's and Gartner's cysts can be traced to the mesonephric duct. Given the rarity of these cysts, there is significant confusion regarding their diagnosis, management, and prognosis. Here, we present the first report of an interlabial mass as a Bartholin's duct cyst in a neonate. The treatment of vaginal cysts is also discussed., (Copyright © 2012 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.)

A 42-year-old multi para, presented with a mass protruding from vagina since 1 year. The mass was cystic in nature arising from the posterior vaginal wall. It was insidious in growth, gradually increasing in size to 8×8 cm. Surgical excision of the cyst was done by sharp and blunt dissection. The cyst was filled with mucoid material and histopathology confirmed a mullerian cyst. Cystic lesions of vagina are relatively uncommon and they are an incidental finding during gynaecological examination. Mullerian cysts are congenital cysts of vagina, usually reported during childbearing age group. These cysts usually arise at the level of cervix and extend anteriorly in relation to bladder, but very rarely they may also extend posteriorly. This paper illustrates a rare case of large posterior vaginal wall cyst of Mullerian origin.

In order to avoid unnecessary therapy or treatment delay, it is important for the radiologist to be aware of the wide range of differential diagnoses for cystic lesions of the female reproductive system. This paper gives an overview of radiological findings in the variety of physiologic and pathologic cysts which may be encountered in this field.

Vaginal wall cysts occur rarely and can cause a variety of symptoms. A 33-year-old woman presented with a 2-week history of vaginal bulging and pelvic pressure. Pelvic examination revealed a protruding cystic mass on the anterior vaginal wall and two small cysts located in the left upper vaginal wall. The pelvic magnetic resonance imaging (MRI) revealed a non-septated homogenous vaginal cyst that was differentiated from the urethral diverticulum. MRI is useful for localizing and differentiating vaginal cysts. However, physical examination is important for the detection and characterization of small cysts.

Benign cystic lesions of the vagina are uncommon and may become symptomatic. We describe two symptomatic anterior vaginal wall cysts in a virgin patient and the usefulness of imaging modalities. A 36-year-old virgin woman presented with a complaint of vaginal bulging and pelvic pressure. Pelvic examination revealed a cystic mass protruding from the vagina surrounded by the intact hymen. The initial abdominopelvic ultrasound showed a hypoechoic cystic mass measuring 42 x 20 mm in the vagina. She then had a pelvic magnetic resonance imaging (MRI) that revealed two anterior vaginal wall cysts with no communication with the urethra or bladder. The cysts were excised and histologic examination with mucicarmine revealed mucin-secreting tall columnar cells consistent with a diagnosis of mullerian cyst. While both ultrasonographic examination and MRI are helpful in localizing vaginal cysts, MRI is superior in showing multiple cystic lesions of the vagina and their communication with the surrounding structures.

Two cases of low-genital-tract-endometriosis are presented. First case is of a big endometriotic cyst of the labia minor, clinically presented as a Bartholin's gland cyst. Second case represents a vaginal cyst which mimics urethral diverticulum. In each case the final diagnosis was determined after the hystopathologial examination. A briefe literature review was done. Endometriotic cysts of the vagina and vulva are rare. Usually they mimic other, more frequently encountered lesions. Not always they have the typical symptoms of endometriosis and there diagnosis is rare determined before the surgical procedure and hystopathological examination. A detailed anamnesis, thorough clinical examination and additional methods (cystoscopic. imaging, sonographic) are needed for the diagnosis. Management consists of a surgical removal of the lesions, hormonal suppression of the ovarian function and, by all means, following up the patients for appearance of a recurrence or of a lesion de novo.

Background: Vaginal cysts occur rarely, are usually discovered incidentally on examination, and can cause a variety of symptoms., Case: This article discusses a 34-year-old para 2 female with a large anterior vaginal wall cyst that arose at 20 weeks' gestation and was originally diagnosed as a cystocele. The unusual timing of its occurrence and the characteristics of the anterior vaginal wall prompted ancillary testing and reexamination., Conclusion: The timing of onset and general characteristics of prolapse as well as defecography and magnetic resonance imaging can be used to aid the gynecologist in diagnosing vaginal cysts instead of the more common condition of vaginal prolapse.

Background: Simple cysts of the female genital tract may become symptomatic and require surgical removal., Case: A 20-year-old woman had complaints of a vaginal bulge, pelvic pressure, dyspareunia, and stress urinary incontinence. Two cystic masses were seen in the vagina. A magnetic resonance imaging scan revealed 2 additional larger cysts. Urodynamic evaluation was significant for stress incontinence at 200 mL and a Valsalva leak-point pressure of 51 cm H(2)0. The 2 smaller cysts were removed intact through a superficial incision. The larger cysts were intentionally ruptured and dissected out. Histologic examination revealed a low cuboidal or a ciliated columnar epithelium that stained positive with mucicarmine, consistent with müllerian origin. One year after surgical excision, the patient remained symptom free with no urinary incontinence and no recurrence of the cysts., Conclusion: Magnetic resonance imaging was useful in delineating the course and anatomic arrangement of the vaginal cysts, but more importantly, identified another cyst that was not readily apparent at physical examination.

Aggressive angiomyxoma (AA) is a rare myofibroblastic tumor, usually affecting young women. Two patients, one with a vaginal and the other with a vulvar mass underwent surgical intervention with different preoperative diagnoses; the former as vaginal cyst and the latter as vulvar hernia. Unfortunately, the pathological evaluation of the specimens revealed aggressive angiomyxoma. Misdiagnosis of this tumor is a common problem.

Objectives: Surgical treatment in which a vaginal mucosa island is buried leads to a risk of epithelial inclusion cyst formation. The aim of this study is to describe this complication, assess incidence, precise facilitating factors and discuss treatment., Patients and Method: This study concerned 84 patients operated on between January 1996 and December 1998. They were treated with modified vaginal wall sling procedure. Fifty women were post-menopausal and 22 had estrogenotherapy. All patients had post-operative surveillance. The mean post-operative follow-up was 19 months (range: 1-68 months). Epithelial inclusion cyst formation diagnosis reposed exclusively on clinical assessment.Results. - Seven out of the 84 patients (8.3%) were diagnosed with epithelial inclusion cyst formation within 19 months of their operation (range: 3-34 months). Out of the seven patients, four were post-menopausal and three had received estrogenotherapy for many years. In six cases, epithelial inclusion cyst was symptomatically revealed by perineal pain or dysuria. These cases were successfully treated by cyst marsupialisation without recurrent incontinence., Discussion and Conclusion: The results of this short study show that epithelial inclusion cyst formation is a specific complication of surgical procedures burying a full thickness of vaginal mucosa and that estrogen impregnation seems to be the main facilitating factor. Successful treatment of symptomatic cases of epithelial inclusion cyst can be achieved by marsupialisation.

Peritoneal endometriosis is probably caused by the implantation of regurgitated menstrual cells. The ovarian endometrioma is the consequence of non-hormone-regulated bleeding from intraovarian epithelial inclusions after they have undergone metaplasia into endometrial-like tissue. Rectovaginal adenomyosis is, in fact, an adenomyotic lesion and can develop from Müllerian rests. In conclusion, peritoneal endometriosis, ovarian endometriosis, and rectovaginal adenomyotic nodules must be considered as three separate entities with different pathogeneses that require a different therapeutic approach.

Purpose: Knowledge of the etiology, evaluation and treatment of cystic lesions of the vagina is essential as these lesions are often encountered in urological and gynecological practices., Materials and Methods: We searched MEDLINE and MeSH for literature from the last 50 years referring to cysts of the vagina. Review of the literature regarding etiology, clinical and pathological diagnosis, prognosis and treatment identified 18 journal articles and 6 books., Results: Benign cystic lesions of the vagina present a spectrum, from small asymptomatic lesions to cysts large enough to cause urinary obstruction. History, physical examination and radiological imaging, including voiding cystourethrogram and magnetic resonance imaging, are useful in diagnosis. Treatment is determined by the severity of symptoms., Conclusions: Cystic lesions of the vagina are relatively common and usually represent benign conditions. A vaginal cyst may be an embryological derivative, ectopic tissue or urological abnormality. Awareness of the various diagnoses of benign cystic lesions of the vagina and associated abnormalities will aid in evaluation and treatment.

Background: Bone marrow transplantation is used in the treatment of a variety of malignancies. One common sequela is graft-versus-host disease (GvHD.), Case: A case of vaginal GvHD in a postmenopausal woman manifested as a 2-cm, cystic, paracervical mass. The patient was followed with consecutive pelvic ultrasounds and pelvic examinations until 27 months after transplantation, when the mass increased in size to 4 x 3 cm. Exploratory laparotomy with total abdominal hysterectomy revealed a 3 x 3-cm phlegmon within the proximal part of the vagina. Presumably, this resulted from vaginal GvHD, causing a midvaginal stricture with obstruction of cervical/uterine effluent., Conclusion: An awareness of the gynecologic manifestations of GvHD is critical for clinicians caring for women undergoing bone marrow transplantation.

The magnetic resonance imaging (MRI) and computed tomography (CT) appearance of 18 paravaginal cysts was reviewed. On MRI, serious cysts were hypointense on T1-weighted and hyperintense on T2-weighted images. Cysts presumed to contain proteinaceous material were hyperintense on T1-weighted and T2-weighted sequences while hemorrhagic cysts exhibited varying stages of hemorrhage. On CT, a high attenuation cyst was presumed to contain proteinaceous material or hemorrhage. MRI and CT examination may reveal paravaginal cysts; their varied appearance must be recognized to avoid confusion with other lesions.

A large Gartner duct cyst associated with solitary crossed renal ectopia was diagnosed in a young woman presenting with dyspareunia and pelvic pain. Among the radiologic imaging modalities used, magnetic resonance imaging and sonography were the most helpful in determining the cystic nature of the mass, its separation from other pelvic organs, as well as its contiguity with the lateral wall of the vagina.

A case is discussed of an extremely large vaginal müllerian cyst that presented as an anterior enterocele. Sonographic and radiologic studies are described. The patient underwent operative excision of the cyst with reconstructive vaginoplasty.

We report a 2.5 cm. vaginal cystic mass in a neonate. The differential diagnosis, evaluation and management of this lesion are discussed.

Although it is well known that biliary sludge can produce fine diffuse echoes within the gallbladder, it is less commonly appreciated that other cystic structures may contain echogenic fluid and therefore be mistaken sonographically for solid lesions. In this article three cases of splenic cysts and one case each of pyrometrocolpos, hydroureter, and pyonephrosis presented with diffuse fine echoes in the fluid. Three of these cases were misinterpreted as a result of this echogenic appearance. These cases serve to emphasize the need for awareness of the echogenicity of some types of fluid and the value of other signs of cystic lesions besides absence of internal echoes.

Gartner's duct cysts and unilateral hematocolpos are unusual conditions presenting as a paravaginal cystic mass. They are frequently mismanaged. Previous authors have cast doubt on the value of laparoscopy and have suggested that primary vaginal drainage is contraindicated. Laparotomy has been performed invariably. In our experience, laparoscopy and primary vaginal drainage has been a safe and successful method of treatment. Three recent cases are reported together with an earlier case.

Retroperitoneal cysts have been classified into traumatic, infective, degenerative, neoplastic, and developmental, according to their origin. This paper focuses on the developmental variety of retroperitoneal pelvic cysts, particularly those of mesothelial, mesonephric, or paramesonephric origin. Their clinical presentations depend on their location; they may be mesenteric, parovarian, or vaginal. The pathogenesis and embryologic, diagnostic, and therapeutic aspects are reviewed and a case report is presented.

The vast majority of vaginal submucosal cysts are benign lesions. Primary malignant tumors of the vagina are infrequent and most are mucosal lesions. A case is described in which an unusual neoplasm, anal duct carcinoma, presented clinically as a vaginal lesion. The importance of considering anal neoplasia in the differential diagnosis of cystic vaginal lesions is noted.

A rare case of uterus duplex, atresia of the right vagina and a fistulisation of a praevesical and parametral absessus is reported. The importance of special gynaecological and urological investigations is stressed, especially if the cystic formation is located in the upper part of the vagina.

The clinical and morphologic features, as well as the classification, of surgically excised cysts of the vagina were reviewed. Sixty-four cysts were available for study. Classification was principally along developmental grounds, based on histologic and histochemical features of cyst epithelium. Detection of epithelial mucus production reduced significantly the incidence of Gartner's duct (mesonephric) cysts, indicating that this is an uncommon lesion. Cysts of mullerian origin, lined mainly by endocervical and occasionally by fallopian tubal epithelium, comprised one-third of the cases. Inclusion cysts of surface mucosa constituted the most common, but usually a clinically insignificant, type of vaginal cyst. Dilation of paraurethral glands and ducts could not adequately explain all the several cysts lined by urothelium. These lesions were difficult to distinguish on clinical grounds, alone, although mullerian cysts were nor symptomatic, due to their greater size.

Gartner's duct cysts will usually be incidental findings during pelvic sonography. Of developmental origin, they may present anywhere along the lateral aspect of the female genital tract. When the cysts are of parovarian origin, they will mimic other fluid-filled adnexal masses, and no specific diagnosis can be made. When alongside the vagina or cervix, however, their ultrasonographic appearance is probably characteristic.