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Müllerian vaginal cyst mimicking pelvic organ prolapse
IUGA Academy. Nessi A. Jun 30, 2018; 212918
Topic: Pelvic Organ Prolapse
Aude Nessi
Aude Nessi

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318

Müllerian vaginal cyst mimicking pelvic organ prolapse

Nessi, A1; Meuwly, J1; Achtari, C1

1: CHUV

Introduction: Few case reports describe vaginal cyst presenting as cystocele (1-3). Müllerian and Gartner duct cysts are rare embryological remnants of the paramesonephros duct (Müllerian) or mesonephros duct (Wolfian or Gartner). Their size varies generally between 1mm to 2 cm, but can sometimes be much bigger. Müllerian cysts are generally located anterolateraly near the vaginal fornix. 40% of the cystic vaginal masses of embryologic origin are Müllerian cysts. Radiologic imaging can help in identifying the localization of cysts in relation to adjacent organs. Dysparunia, pelvic pain, pressure, bulging mass and urinary incontinence are the most frequent presenting symptoms associated with vaginal cyst.(1)

Objective: This is a case report describing a large Müllerian cyst presenting as a C3H2R2 vaginal prolapse.

Methods: A 41 year-old Para 3, otherwise healthy woman, presented with C3H2R2 prolapse according to POP-Q testing, in aggravation since her second pregnancy. She had no urinary incontinence complaints. A conservative treatment with pessary was tried, but was not found to be satisfactory. Five months before she was referred to us she reported pain in the right iliac fossa and underwent a CT scan, that described a 80x40x30mm right pelvic homogenous fluid collection of unknown origin. A diagnostic laparoscopy was performed and the only finding was a slight retroperitoneal bulging near the right uterosacral ligament. The surgeon concluded to a venous vs lymphatic stasis. One month later, MRI imaging was performed for persisting pelvic pain and was unremarkable apart from the pelvic organ prolapse, but no fluid-like collection was described. She was referred to our center for surgical management of the prolapse. She underwent a laparoscopic sacrocolpopexy, during which the slight peritoneal bulging was seen again. The 6-weeks postoperative clinical exam showed persistent cystocele with no recurrent hysterocele. A repeat MRI highlighted the presence of a large cyst of vaginal origin. A detailed review of the radiologic exams concluded that it was a cyst of vaginal origin with wandering fluid passing from the vagina to the right posterior fornix through a thin collar located next to the cervix like a hourglass, at the origin of the prolapse. This cyst was subsequently managed by surgery. Histology diagnosis was of a Müllerian cyst lined by endocervical cells, secreting mucinous fluid inside this cyst.

Conclusions: No case report has ever described hysterocele associated with Müllerian vaginal cyst. However it is not possible to definitively conclude if the cyst was mimicking a vaginal prolapse or whether it was a true prolapse associated with wandering content of a large Mullerian cyst.

  1. CROG 10.1155/2015/376834
  2. O&G 2017;130;1039-41
  3. JMIG 10.1016/2017 .01.003

Disclosure:

Work supported by industry: no.

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