|Year : 2023 | Volume
| Issue : 2 | Page : 182-187
Can Gartner’s duct cyst trigger marital disharmony? A case report
Olanrewaju S Jimoh, Rofiat T Lemboye-Bello, Olawale O Ogunjinrin, Adewale M Alayo
Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta, Nigeria
|Date of Submission||16-Nov-2022|
|Date of Decision||09-Dec-2022|
|Date of Acceptance||12-Feb-2023|
|Date of Web Publication||21-Mar-2023|
Olanrewaju S Jimoh
Department of Obstetrics and Gynaecology, Federal Medical Centre, Abeokuta
Source of Support: None, Conflict of Interest: None
Gartner’s duct cyst (GDC) is a remnant of the mesonephric (Wolffian) duct in females. The GDC is formed from the persistence of some portions of the mesonephric duct in adult females resulting in small-sized cysts usually in the anterolateral vaginal wall but could be found elsewhere along the tract of the duct. The case of a 33-year-old para 5+1 (three alive) woman who had GDC is reported. The patient presented with incidental findings of a vaginal mass during gynecological evaluation and subsequently had dyspareunia. A provisional diagnosis of GDC was made and this was confirmed by transvaginal ultrasound. The patient had transvaginal excision of the cyst and histological confirmation of a benign cystic lesion with the diagnosis of GDC. GDC is a rare entity and clinical examination revealing a cystic vaginal wall mass with or without symptoms should raise a high suspicion of this condition.
Keywords: Benign, dyspareunia, Gartner’s duct cyst, mesonephric duct, transvaginal
|How to cite this article:|
Jimoh OS, Lemboye-Bello RT, Ogunjinrin OO, Alayo AM. Can Gartner’s duct cyst trigger marital disharmony? A case report. Int J Med Health Dev 2023;28:182-7
|How to cite this URL:|
Jimoh OS, Lemboye-Bello RT, Ogunjinrin OO, Alayo AM. Can Gartner’s duct cyst trigger marital disharmony? A case report. Int J Med Health Dev [serial online] 2023 [cited 2023 May 28];28:182-7. Available from: https://www.ijmhdev.com/text.asp?2023/28/2/182/372160
| Introduction|| |
Gartner’s duct cyst (GDC) is often an asymptomatic cystic lesion that originates from the remnant of the mesonephric duct in females. The commonest site is on the anterolateral part of the upper third of the vagina. Gartner’s ducts are found in one-fourth of all adult females but only 1% would develop GDC.
| Case Report|| |
Mrs. K.B. was a 33-year-old para 5+1 (three alive) woman who presented to the gynecological clinic with a history of a mass in the vagina which was first noticed 3 years before the presentation and painful sexual intercourse of 6 months duration.
The mass was incidentally discovered at the family planning clinic as a small swelling on the upper lateral wall of the vagina when she presented for removal of an intrauterine device (Cu-T 380A) and it has slightly increased in size since it was first noticed. Mrs. K.B. was then referred to the gynecological clinic for further evaluation. She, however, did not present until when she started having painful sexual intercourse. The pain was during deep penetration and this had significantly affected her sexual life as the husband had expressed his intention of seeking sexual pleasure outside of the union by considering a polygamous marriage. She is married to a Muslim, 35-year-old, civil servant in a monogamous union. There was no history of abdominal pain, abnormal vaginal discharge, post-coital bleeding, genital ulcer, abdominal swelling, weight loss, or previous vaginal trauma. There was no history of urinary symptoms.
Physical examination revealed a young woman, healthy-looking, not pale, anicteric, acyanosed and she was not dehydrated. The respiratory rate was 16 cycles per minute and the chest was clear clinically. The pulse rate at presentation was 80 beats per minute and blood pressure was 100/70 mmHg. There was no abnormality detected on the abdominal examination.
Perineal examination showed no ulcer or nodule on the vulva and the urethral orifice appeared normal. Sterile speculum examination revealed a normal-looking cervix with a 3 × 3 cm mass seen on the lateral part of the vaginal wall close to the left lateral fornix, it was round, smooth-surfaced, and cystic with a thin wall [Figure 1]. There was mild tenderness and no contact bleeding from the cervix on digital vaginal examination. An assessment of vaginal wall mass possibly a GDC was made with inclusion cyst of the vagina as a differential diagnosis.
|Figure 1: The Gartner’s duct cyst on the vaginal wall in close proximity to the left lateral fornix|
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A transvaginal ultrasound scan revealed a 33 × 30 mm anechoic cystic mass with no solid component in the upper third of the vagina close to the cervix with no other abnormality seen in the pelvis. A transabdominal ultrasound scan to assess the kidneys, ureters, and bladder was normal. Papanicolaou’s smear was negative for intraepithelial neoplasia and the colposcopy revealed a cystic vaginal mass with a healthy cervix [Figure 2].
|Figure 2: Colposcopy revealed a vaginal wall cyst and no other abnormal findings|
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Renal function and other tests were essentially normal. Mrs. K.B. and her husband were counseled on the diagnosis and the available options of management. They chose surgical excision and consented immediately because the dyspareunia as well as the low sexual drive of the patient was causing marital disharmony. They were also instructed to visit the clinical psychologists and the social support workers which they did.
She subsequently had an examination under anesthesia and an excisional biopsy performed with intraoperative findings of the normal-looking female external genitalia, healthy-looking cervix, 3 × 3 cm cystic mass at the upper third of the vagina close to the left lateral fornix, clear postoperative urine, and blood loss at surgery was minimal. The cystic mass was excised completely using careful sharp and blunt dissections after making a circumferential incision around the base, the defect as well as the vaginal mucosa was closed with polyglactin 910 (vicryl) 2-0 sutures [Figure 3] and [Figure 4]. She was discharged on the day of the surgery on oral analgesics, antibiotics, and for follow-up at the gynecological clinic.
Mrs. K.B. was seen 2 weeks after surgery and a vaginal examination revealed good wound healing with no swelling, erythema, or vaginal discharge. Histology report showed a round cystic mass of 3 cm in diameter covered with the vaginal skin and the cut section revealed a unilocular cyst containing colorless gelatinous fluid. The cyst wall showed cuboidal epithelium embedded in the stratified squamous epithelium of the vaginal mucosa [Figure 5]. She was encouraged to start sexual intercourse with her partner in about 4–6 weeks. They were counseled on gentle penetration and the use of sterile water-based lubricants to minimize discomfort. Mrs. K.B. also had no complaint at the 6-month follow-up visit, there was no report of recurrence thus far.
|Figure 5: Hematoxylin and Eosin stain (H&E) stain × 100 magnification showing a large cyst lined by cuboidal epithelial cells with overlying stratified squamous epithelium of the vagina|
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| Discussion|| |
GDC is formed from the remnant of the mesonephric duct in females and is often less than 2 cm in size but sometimes bigger. During embryonic development, the paramesonephric duct developed to form the female reproductive organs (fallopian tubes, uterus, cervix, and upper two-thirds of the vagina) whereas the mesonephric duct, under the influence of testosterone produced by the fetal testes at the 8th week of development, formed the male genital organs. Sometimes, the mesonephric duct, which should ideally regress in females, remains persistent as a vestigial organ along the tract of the duct to form GDC., Usually, the cyst is not continuous with either the uterus or vagina making it an enclosed cystic mass commonly located in the anterolateral wall of the vagina as seen in our patient, though some have been reported in the posterior wall.,,
GDC is usually asymptomatic and is mostly detected incidentally during routine gynecological evaluation.,, It could however increase in size due to the accumulation of fluid and mucus within the cyst thereby becoming symptomatic. Documented symptoms include; dyspareunia as seen in our patient, protrusion of mass from the vagina, itching, vaginal discharge, pelvic pain, and urinary symptoms.,, Dyspareunia could be as a result of the forceful impact of the penile shaft on the cyst during sexual intercourse via the vaginal route. Diagnosis of GDC might be challenging because of similarities with other entities such as Bartholin cyst or abscess, cystocele, urethral diverticulum, inclusion cysts of the vaginal wall, ureterocele, vaginal wall leiomyoma, sarcoma botyroides, skene’s gland cyst or abscess, and endometriosis., GDC could be differentiated from other similar lesion as it is usually located in the lateral vaginal wall and is often asymptomatic.
Transvaginal ultrasound is a very useful tool in the diagnosis of GDC. Also, abdominal ultrasound could help to rule out associated abnormalities of the urinary tract. Computerized tomography scans (CT scans) and magnetic resonance imaging (MRI) give a detailed and superior visualization of the cyst and the surrounding structures. Despite the added advantages of CT scans and MRI in the accuracy of diagnosis, they are not readily available and relatively expensive in low-resource settings hence thorough pelvic examination and ultrasonography are acceptable for the majority of cases. Our patient had a Papanicolaou smear and colposcopy to discern any other lesion of the cervix and vagina.
GDC can be managed expectantly in asymptomatic cases. Symptomatic cysts are managed through aspiration and sclerotherapy with an intracystic injection of tetracycline., Cyst marsupialization is a simple procedure with minimal surgical scarring, has good outcomes, and serves as a safe alternative when excision of the cyst is difficult. Cyst excision is a recommended modality of treatment with proven results and is the mainstay of management in cases of symptomatic, large cysts including extremely rare cases of malignant transformation., Mrs. K.B. had an excision because of the symptoms of dyspareunia she presented with. Confirmation of the diagnosis is via histology following the excision of the mass as seen in our patient. Recurrence of the cyst is managed with regular surveillance, sclerotherapy, and marsupialization of the cyst into the peritoneal cavity.
| Conclusion|| |
GDC presenting with dyspareunia and affectation of sexual life is rarely documented and mostly under-reported. Management should be multidisciplinary involving gynecologists, sex psychologists, and social support workers. Following treatment of GDC with dyspareunia, sexual partners have a role to play in the restoration of the self-esteem of their spouses.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that her names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
The authors did not receive any financial support or grant for this publication.
Taking of patient’s history: OSJ/OOO/RTL. Ward rounds/review: OSJ/RTL/AMA. Surgery: OSJ/OOO/RTL. Interpretation of surgical findings: OSJ/OOO/RTL/AMA. Case report writing: OSJ/OOO. Editing of case report: AMA/RTL. Proofreading before final submission: OSJ/AMA.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]