Cyst of Canal of Nuck in a 62-Year-Old Woman: Case Report of a Rare Disease

Abstract

Introduction: Cyst of Nuck in women is a rare development disorder corresponding to hydrocoele of the spermatic cord in males; it can be associated with inguinal hernia in 30-40% of cases. Only 400 cases have been described in literature and in there are no older than 50. Case Presentation: A 62-year-old presented a right aching inguinal swelling. On physical examination the mass was not reducible, without signs of incarceration or strangulation. On ultrasound the lesion was mostly hypoechoic. CT saw an over liquid lesion, confirmed on MRI as a lesion hypointense in T1 and hyperintense in T2. The patient underwent open surgery: the cyst was separated from the round ligament and excised in mass and the defect was repaired with a prolene mesh. The histopathological exam confirmed the hydrocoele (calretinin positive, mesothelial cells on the inner surface). Discussion: The canal of Nuck is a small evagination of the parietal peritoneum that accompanies the round ligament into the inguinal canal during the first year of female development and is normally obliterated in the first year of life. Failure of obliteration of Nuck canal results in a hydrocoele that could develop intraabdominal or extra – abdominal or both. Ultrasound shows a thin walled, well defined, echo free cystic structure but the perfect diagnosis is given by MRI. Therapy is surgical and it can be open or, more recently, laparoscopic, depending on the expertise of the surgeon. Conclusion: A cyst of Nuck is a rare condition but it should always be considered in differential diagnosis of cystic inguinal lumps in women. Most of the reported cases concern children and young men. To our knowledge this is the only case regarding a more than 50-year-old.