Symptomatic cervical macrocyst as a late complication of subtotal hysterectomy. A case report

Ablation of the endocervical canal is sometimes performed as an adjunct to subtotal hysterectomy in an attempt to reduce mucous discharge and the risk of future neoplasia. Cystic accumulations within the canal of a partially obliterated cervical stump have not previously been reported to follow this practice.

A 41-year-old woman presented with subacute cramping and cystic enlargement of the cervical stump on clinical, sonographic and magnetic resonance evaluation four years subsequent to a subtotal hysterectomy performed for menorrhagia. Cervical biopsies and cytology were benign, and vaginal trachelectomy was performed. Pathology demonstrated the fluid pocket to be a very large retention cyst (nabothian) that had occupied and distended the partially obliterated endocervical canal.

Ablation of the cervical canal at subtotal hysterectomy may result in symptomatic entrapment of nabothian cysts. Internalization of the transformation zone and partial obliteration of the canal are postulated as predisposing factors.