Gartner's Duct Cyst Research Articles

Clinical Manifestations and Outcomes in Surgically Managed Gartner Duct Cysts

Study ObjectiveGartner duct cysts (GDCs) are rare embryological remnants of the mesonephric duct with the majority of cases discovered incidentally in asymptomatic patients. The largest prior published series evaluating the surgical management of GDCs included 4 patients. The present study aimed to determine the manifestations and outcomes of surgically managed patients with GDCs with important implications for surveillance, monitoring, and management. DesignA retrospective chart review (Canadian Task Force classification III). SettingA tertiary care center. PatientsAll women diagnosed with GDCs from January 1994 to April 2014 at our institution were identified. Patients were included if they underwent surgical management and had GDCs confirmed by pathology. One hundred twenty-four charts were manually reviewed, and 29 patients were included in the analysis. InterventionsAll patients underwent surgical management, which included vaginal excision or marsupialization. Measurements and Main ResultsA total of 29 patients met the inclusion criteria for this study. The median age of the patients included in the analysis was 36 years old. Eleven patients were asymptomatic at the time of diagnosis (37.9%). The reason for surgical intervention was not available in 9 of these patients. Surgical intervention was performed in 2 of the 11 asymptomatic patients because of an increasing size of the lesion during observation. Presenting symptoms included dyspareunia or pain with tampon placement (37.9%), pelvic pain or pressure (24.1%), pelvic mass or bulge (17.2%), and urinary incontinence (6.9%). Preoperative imaging studies were obtained in 62% of patients; ultrasound was used in 44.4%, computed tomographic scanning in 22.2%, magnetic resonance imaging in 16.7%, and multiple modalities in 16.7%. Approximately 10% were found to have other genitourinary anomalies, including a bladder cyst, urethral diverticulum, and a solitary right kidney with uterine didelphis and septate vagina. The average cyst size was 3.5 cm (±1.8 cm). Surgical excision of GDCs was performed in all except for 3 cases of marsupialization. No intraoperative complications occurred. The median follow-up was 82 months (range, 0–246 months). One patient had possible recurrence with dyspareunia and protruding tissue diagnosed 14 months postoperatively. There were no other postoperative complications in the follow-up period. ConclusionGDCs are rare pelvic masses that are often asymptomatic but may present with dyspareunia, pelvic pain or pressure, pelvic mass or bulge, or urinary symptoms. Excision or marsupialization is successful in the majority of cases without significant morbidity.

Unusual presentation of a Gartner duct cyst in early pregnancy

Introduction: Gartner ducts are vestigial remnants of the mesonephric ducts that regress after the eighth week of embryologic development. In the adult female, remnant Gartner ducts from the mesosalpinx to the cervix via the broad ligament and are typically located along the anterolateral vaginal wall. Cysts can arise when the ducts become obstructed and secretions from the remnant epithelium accumulate. Gartner duct cysts represent only about 11% of benign vaginal cysts. They often occur in pregnancy, but typically in the third trimester.Aim of Study: The purpose of this case report is to present a very unusual case of Gartner duct cyst that presented during the first trimester of pregnancy with our management strategy.Patients and Methods: After a 19-year-old primiparous patient presented with a painful midline vaginal mass in her first trimester, ultrasound and MRI were used to obtain the diagnosis of Gartner duct cyst. Bedside incision and drainage was performed to avoid general anesthesia for surgical excision.Results: The patient’s symptoms resolved after drainage, and she continued her pregnancy without complication. Complete healing of prior incision occurred with mild re-accumulation of glandular fluid. The patient had further symptoms.Conclusion: Gartner duct cyst should be on the differential diagnosis for a woman who has a midline vaginal cyst, even though they more typically occur more laterally. General anesthesia in the first trimester of pregnancy should be avoided. Therefore, we suggest bedside incision and drainage as an option for the management of symptomatic Gartner duct cysts in the patient who is not the ideal candidate for surgical excision

Perivaginal benign masses: diagnosis and therapy in a series of 66 women.

Benign perivaginal masses (PVM) are relatively rare. The aim of this study is, to create a higher awareness for these entities and to point out reliable diagnostics and an accurate treatment. The medical records of the Department of Obstetrics and Gynecology Tuebingen were searched for number and type of urogynecological surgery in general, and a surgery, which took place particularly owing to benign PVM, over a period of 5years. Diagnostics, treatment, histology and postoperative management were summarized and analyzed. Vaginal endometriosis manifestations were not considered. Between 2011 and 2015 a total number of 4.157 women underwent urogynecological surgery, 65 (1.6%) of these particularly because of benign PVM. The benign PVM in the patient cohort were composed as follows: urethral diverticula (UD), squamous epithelial inclusion cysts, periurethral cysts, Gartner's duct cysts, Müllerian cysts, pseudocysts, abscesses, epidermal inclusion cysts, angiofibromas, angiomyofibroblastomas, leiomyomas, solitary fibrous tumor and masses due to alloplastic materials. The PVM occurred singly or multiply. They were asymptomatic or accompanied by symptoms. Case history, clinical examination, pelvic floor sonography, urethrocystoscopy and MRI are essential tools for diagnostics. PVM simulated cystoceles and recto/enteroceles, were cause of an overactive bladder, dyspareunia, pain or were concomitants in women with stress urinary incontinence. The PVM were excised in 65 out of 66 cases, in one case an infected UD regressed completely under conservative antibiotic therapy. The awareness for benign PVM is helpful for their diagnostics and management. As secondary pathology, intradiverticular stones and malignancy have to be considered.

Aggressive Angiomyxoma of the Vulva in a Teenager, a Case Report and Review of Literature

Background: Aggressive angiomyxoma (AA) is a rare, locally aggressive mesenchymal neoplasm that commonly involves the vulvoperineal region of females in reproductive age [1]. AA commonly presents as a painless, gelatinous soft mass of varying size [1]. It carries a high risk of local recurrence and can rarely metastasize [1]. Aggressive angiomyxoma is often misdiagnosed because it is such a rare tumor, therefore it should always be included in the differential diagnosis of vulvar masses. The rate of misdiagnosis varies from about 70-100% [2]. It must also be distinguished from a variety of other more common benign and malignant myxoid tumors. Along with this, it should also be differentiated from Bartholin cysts, Gartner duct cyst and from a vulval lipoma [3]. The differential diagnosis should include neurofibromas, desmoids tumors, leiomyomas, sarcomas and levator hernia [4,5]. The treatment of choice for aggressive angiomyxoma is surgical excision with wide margins to help prevent local recurrences [6]. A perineal surgical approach is often most successful. The tumor can recur at any time, therefore close monitoring of the patient is necessary following surgery. Case: We present a case of aggressive angiomyxoma of the vulva in a 20-year-oldcelibate female. The patient underwent wide local excision of the tumor with clear margins. Conclusion: Aggressive angiomyxoma (AA) is a mesenchymal tumor that most commonly occurs in women between the ages of 31-35 years old [3]. The tumor usually occurs in either the perineal or pelvic region and typically presents as a slow growing, painless mass [7]. AA is considered to be an aggressive tumor because it has a high risk of infiltration and local recurrence. However, it rarely metastasizes so it has an overall good prognosis [8]. This case highlights the need to consider angiomyxoma in the differential diagnosis for tumors of unknown cause in the vulvar region [7]. Even though it is a rare diagnosis, it must be identified in order to properly treat it and prevent invasion of local structures. Histopathology is the key to correctly diagnosing this mass. Magnetic resonance imaging (MRI) can help provide additional information about the size and extent of the tumor as well. Surgical excision of the tumor with wide margins to prevent local recurrence is the treatment of choice [6]. Alternative treatments such as GnRH agonists can aid in treatment as well by decreasing the size of the tumor prior to surgery. Since the local recurrence rate is about 30-72%, close monitoring after surgery is extremely important.

The Case Files

A 19-year-old woman with no past medical or surgical history presented to the emergency department stating that she had noticed a growth protruding from her vagina. It has been painless except during intercourse and constant in all characterizations since detection three days earlier. She denies vaginal bleeding, urinary retention, incontinence, fever, injury, and back, abdominal, and pelvic pain. Her vital signs are normal, but her physical examination was significant for a 2.5 cm x 4 cm stalk-like, pedunculated, fluctuant, nontender, mobile, cystic-appearing mass protruding from the right anterolateral vaginal wall. The rest of the genitourinary and abdominal systems were without notable abnormalities and pathology. A blood sample sent to the lab failed to note leukocytosis, and urinalysis and pregnancy tests were negative. A supporting ultrasound was obtained, a Gartner's duct cyst was diagnosed, and gynecological follow-up was made for marsupialization to prevent a recurrence. Gartner's ducts are identified in approximately 25 percent of all adult women, and nearly one percent evolves into Gartner's duct cysts. The mesonephric (Wolffian) ducts develop during embryological development, form their predetermined structures, and later regress. Remnants often remain, however, until they develop a secretory mechanism, cause dilation of surrounding cells, and yield a Gartner's duct cyst, most often during and after late adolescence. Classically, the cysts are solitary, unilateral, less than 2 cm in diameter, and are located in the anterolateral vaginal wall of the proximal third of the vagina. (J Gynecol Surg 2009;1[2]:94; J Pelvic Med Surg 2007;13:141.) Gartner's duct cysts are generally asymptomatic, and most commonly diagnosed upon routine gynecologic examination, but patient complaints can include skin tag, dysuria, pressure, itching, dyspareunia, pelvic pain, or protrusion from the vagina if it enlarges to a detectable size, making it a candidate for surgical removal. (J Diagn Med Sonog 2008;24:344; J Pelvic Med Surg 2007;13:141; J Am Osteopath Assoc Dermatol 2007;8:40.) The cyst can be drained to facilitate delivery if it is large enough to cause obstetrical complications.FigureMRI can be a useful tool to define the course of the Gartner's duct cyst and differentiate it from other pathologic considerations and structures. Histologic examination may be employed to correctly identify the cellular remnants composed of non-mucin secreting low columnar or cuboidal epithelium, but it is not necessary in clinical practice. (J Diagn Med Sonog 2008;24:344.) The differential diagnosis can include but is not limited to Bartholin's gland cyst or abscess, prolapsed urethra, prolapsed uterus, vaginal wall inclusion cyst, endometriosis, leiomyoma, sarcoma botryoides, malignant mass, Skene's gland cyst, or abscess and ureterocele. (J Am Osteopath Assoc Dermatol 2007;8:40.) Only in exceptionally rare and isolated cases has a malignant transformation been identified. (Int J Gynecol Cancer 2009;19[9]:1655.) Patients may be discharged safely from the emergency department with gynecologic follow-up for definitive treatment.

An Unusual Case of Anterior Vaginal Wall Cyst

ABSTRACT Vaginal cysts are rare and are mostly detected as an incidental finding during a gynecological examination. Gartner duct cysts, the most common benign cystic lesion of the vagina, represent embryologic remnants of the caudal end of the mesonephric (Wolffian) duct. These cysts are usually small and asymptomatic and have been reported to occur in as many as 1% of all women. A 17-year-old unmarried girl presented with mass per vagina since one and a half year. On examination, anterior vaginal wall cyst of 8 × 4 × 3 cm was detected. Surgical excision of the cyst was done under spinal anesthesia by sharp and blunt dissection. The cyst was filled with mucoid material and histopathological examination confirmed Gartner origin. This is a rare case of large Gartner cyst. How to cite this article Anitha GS, Prathiba M, Gowri M. An Unusual Case of Anterior Vaginal Wall Cyst. J South Asian Feder Obst Gynae 2015;7(3):227-230.

Clinical Manifestations and Outcomes in Surgically Managed Gartner Cysts

Gartner duct cysts (GDC) are rare embryological remnants of the mesonephric duct with the majority of cases discovered incidentally in asymptomatic patients. The largest prior published series included 5 cases. The present study aims to determine the manifestations and outcomes of surgically managed patients with GDC with important implications for surveillance, monitoring, and management of patients.

Gartner Duct Cyst: CT and MRI Findings.

Gartner Duct Cyst: CT and MRI Findings.

A Central Gartner's Duct Cyst, Unilateral Renal Agenesis, Didelphic Uteri and Paratubal Cyst Presenting as Pain and Fever: A Case Report and Review of the Literature

A Gartner's duct cyst (GDC) is a benign vaginal cystic lesion that arises from the mesonephric duct. GDC are usually small asymptomatic cysts that occur along the lateral walls of the vagina, but may enlarge. The ureteral bud also arises from the mesonephric duct. If the ureteral bud is located high or low with respect to the metanephric blastema, a dysplastic or hypoplastic kidney may result. The rare combination of GDC and unilateral renal agenesis has been reported in the literature, half of which are also associated with müllerian duct abnormalities.

Prolapsing vaginal Mullerian cyst with cervical elongation mimicking cystocele

Benign cystic lesions of the vagina are relatively uncommon. Among them, Mullerian cysts and squamous inclusion cysts are the least rare, followed by mesonephric (Gartner's duct) cysts and Bartholi...

A rare case of recurrent cystic Gartner's duct in a crossbred heifer and its successful management

Summary Description of a rare recurrent Gartner's duct cyst associated with yeast infection in a crossbred heifer is reported. The recurrence was caused by uncontrolled yeast infection that showed in vitro sensitivity to oxytetracycline. Administration of local clotrimazole and systemic oxytetracycline as per recommended therapeutic dose regime resulted in complete recovery.

Recién nacida con tumoración genital interlabial de resolución espontánea. Caso clínico

Interlabial masses of newborns are rare issues that fall into the interest of pediatricians, pediatric surgeons, urologists, dermatologists and gynecologists. The most common are the hymenal cysts and paraurethral gland cysts. Several interlabial masses, including those of embryological origin, ectopic tissue, prolapse, urological anomaly, or neoplasia, can superficially resemble simple cysts. These include prolapsed urethra, prolapsed ectopic ureterocele, prolapsed vagina or uterus, Gartner's duct cyst, hydrometrocolpos associated with an imperforate hymen and botryoid rhabomyosarcoma. The differential diagnosis is important both for treatment approach and for follow up. We present a 3- day- old baby girl patient diagnosed with hymenal cyst.

Case Report: Gartnerʼs Duct Cyst

ImageA 19-year-old woman with no past medical or surgical history presents to the emergency department stating that she noticed a growth protruding from her vagina. It has been painless except during intercourse and constant in all characterizations since detection three days earlier. She denies vaginal bleeding, urinary retention, incontinence, fever, injury, and back, abdominal, and pelvic pain. Her vital signs are normal, but her physical examination was significant for a 2.5 cm x 4 cm stalk-like, pedunculated, fluctuant, nontender, mobile, cystic-appearing mass protruding from the right anterolateral vaginal wall. The rest of the genitourinary and abdominal systems were without notable abnormalities and pathology. A blood sample sent to the lab failed to note leukocystosis, and urinalysis and pregnancy tests were negative. After a supporting ultrasound was obtained, a Gartner's duct cyst was diagnosed, and a gynecological follow-up was made for marsupialization to prevent a recurrence. Gartner's ducts are identified in approximately 25 percent of all adult women, and nearly one percent evolve into Gartner's duct cysts. During embryological development, the mesonephric (Wolffian) ducts develop, form their predetermined structures, and later regress. Remnants often remain, however, until they develop a secretory mechanism, cause dilation of surrounding cells, and thus yield a Gartner's duct cyst, most often during and after late adolescence. Classically, the cysts are solitary, unilateral, less than 2 cm in diameter, and are located in the anterolateral vaginal wall of the proximal a third of the vagina. (J Gynecol Surg 2009;24:75; J Pelvic Med Surg 2007;13:141.) Gartner's duct cysts are generally asymptomatic, and most commonly diagnosed upon routine gynecologic examination, but patient complaints can include that of skin tag, dysuria, pressure, itching, dyspareunia, pelvic pain, or protrusion from the vagina if it enlarges to a detectable size, making it a candidate for surgical removal. (J Diagn Med Sonog 2008;24:344; J Pelvic Med Surg 2007;13:141; J Am Osteopath Assoc Dermatol 2007;8:40.) If large enough to cause obstetrical complications, the cyst can be drained to facilitate delivery. To define the course of the Gartner's duct cyst and differentiate it from other pathologic considerations and structures, MRI can be a useful tool. Histologic examination may be employed to correctly identify the cellular remnants composed of non-mucin secreting low columnar or cuboidal epithelium, but in clinical practice, it is not necessary. (J Diagn Med Sonog 2008;24:344.) The differential diagnosis can include but is not limited to Bartholin's gland cyst or abscess, prolapsed urethra, prolapsed uterus, vaginal wall inclusion cyst, endometriosis, leiomyoma, sarcoma botryoides, malignant mass, Skeene's gland cyst, or abscess and ureterocele. (J Am Osteopath Assoc Dermatol 2007;8:40.) Only in exceptionally rare and isolated cases has there been a malignant transformation identified. (Int J Gynecol Cancer 2009;19[9]:1655.) Patients may be discharged safely from the emergency department with gynecologic follow-up for definitive treatment. Dr. Letiziais the director of operations and an emergency physician at Trinitas Regional Medical Center in Elizabeth, NJ.Mr. Kellyis a fourth-year medical student at Spartan Health Sciences University in St. Lucia.

A case of Gartner's duct cyst arising from the cervix resected by laparoscopic surgery

A case of Gartner's duct cyst arising from the cervix resected by laparoscopic surgery

A Modified Approach of Cystic Puncture With Contrast Medium Injection for Diagnosis of Obstructed Hemivagina and Urinary Tract Anomalies

This study investigated the diagnostic value of a modification of the conventional technique of X-ray imaging after cystic puncture with injection of contrast medium for obstructed hemivagina and related urinary tract anomalies in girls. The modified procedure made the following diagnostic findings: ipsilateral obstructed hemivagina in one patient with renal agenesis; vaginal ectopic ureter and ipsilateral obstructed hemivagina in one patient with renal dysplasia; and vaginal ectopic ureter, Gartner's duct cyst and ipsilateral obstructed hemivagina in six patients with renal dysplasia or aplasia. This modified method might have improved diagnostic value over the traditional method, and accurately identify genitourinary tract anomalies. It could therefore serve as an alternative and complementary method of sonography.

Retrovesical cystic lesions in female patients with unilateral renal agenesis or dysplasia

To review our experience with female children who have unilateral renal agenesis or renal dysplasia associated with cystic lesions in the reproductive system. Between 1991 and 2007, we treated 26 patients with unilateral renal agenesis or renal dysplasia associated with pelvic, retrovesical or interlabial cystic lesions. In 16 patients, an abnormality either of the kidney or a cystic lesion was detected during the perinatal period. Another 10 patients presented clinical symptoms, including urinary incontinence in five, urinary tract infection in one, and vaginal discharge in four. Based on clinical features and imaging findings, the patients were divided into four groups: those with Gartner's duct cyst (Group 1, n = 9); those with uterovaginal duplication with obstructed hemivagina (Herlyn-Werner-Wunderlich syndrome [HWW]; Group 2, n = 3); those with both Gartner's duct cyst and HWW syndrome (Group 3, n = 3); and those without definitive diagnosis (Group 4, n = 11). In Group 1, leakage completely stopped after nephrectomy in three patients, whereas six patients continued to be incontinent despite the removal of dysgenetic kidneys. In Group 2, after the excision of a vaginal septum, no patient presented urinary incontinence. In patients in Group 3, both the mesonephric remnant and mullerian structures were confirmed on imaging or through endoscopy. Because of the high coincidence of genital and renal anomalies, it is recommended that genital systems in female patients with renal anomalies associated with cystic lesions behind the lower urinary tract be investigated. The best imaging modality to use remains under scrutiny. It is importantt to follow the patients until the age of puberty. The importance of a long-term follow-up in these patients needs to be emphasized.

Blind hemibladder, ectopic ureterocele, or Gartner’s duct cyst in a woman with Müllerian malformation and supposed unilateral renal agenesis: a case report

Genital anomalies associated with unilateral renal agenesis are generally due to agenesis or hypoplasia of the entire urogenital ridge or distal mesonephric aberrations. However, renal adysplasia could also occur in association with anomalies of the ventral urogenital sinus. The patient presented didelphys uterus in the superior uterine segment, a septate cervix, and a simple vagina. After transvaginal puncture and injection of a contrast agent into the bulge observed in the right vaginal wall, a filled sac or cavity was detected, possibly a hemibladder. This structure continued upward with a possible dilated tortuous ureter that filled retrogradely. Magnetic resonance imaging also showed the presence of the right blind paravaginal sac. Right hemitrigone and ureteral orifice were absent in the cystourethroscopy. No right kidney was found, despite the use of multiple imaging techniques. Blind hemibladder, ectopic ureterocele, and Gartner's duct cyst seem to be a possible diagnosis associated to Müllerian malformations and supposed unilateral renal agenesis. Therefore, Müllerian anomalies without combined mesonephric alteration could be associated with conditions of the ventral urogenital sinus, including blind hemibladder or ectopic ureterocele with secondary renal dysplasia.

Symptomatic Giant Gartner's Duct Cyst of the Vagina

Background: Gartner's duct cysts are remnants of Wolffian ducts, which are usually found in the upper anterolateral part of the vagina. Gartner's cysts are remnants of mesonephric (Wolffian) ducts, which, in women are present in the uterus, vagina, and hymen until the third month of gestation and which give rise to the ureter. Remnants of the Gartner duct may be detected in up to one fourth of adult women, although Gartner's cysts arise only in approximately 1%–2% of the population. Most Gartner's cysts are small (< 3 cm), and they are usually paravaginal and in the anterolateral position; however, they can be large and cause urethral or even ureteric obstruction. Infrequently, giant Gartner's duct cyst has been reported in the literature.

A Giant Gartner Duct Cyst Originating from the Uterine Cervix and Adjacent Myometrium: A Case Report

Gartner duct cysts are relatively common congenital cysts in the anterolateral wall of the vagina. Most are small (less than 2 cm) and asymptomatic, but larger cysts may cause problems. We report a rare case of a giant Gartner duct cyst (7 cm) originating from the right lateral portion of the uterine cervix and adjacent myometrium. It appeared as an exophytic multiseptated cystic mass containing different density fluids on CT.

Gartner duct cyst in pregnancy presenting as a prolapsing pelvic mass

Gartner duct cysts are the remnants of the Wolffian duct and they are rarely seen in adulthood. We present a case of a pregnant patient with a prolapsing vaginal mass. A diagnosis of Gartner duct cyst was made after MRI was performed. The Gartner duct cyst was drained when the patient went into labour allowing vaginal delivery to be performed.