Vaginal cysts: a common pathologic entity revisited

To further study the clinicopathological features of benign vaginal cysts.

We retrospectively studied all cases of benign vaginal cysts diagnosed in our laboratory over the last decade. Pathological findings were correlated with the clinical records of the patients and histochemistry results.

Forty cases of benign vaginal cysts were retrieved. There were 12 cases of mullerian cysts (30.0%), 11 cases of Bartholin's duct cysts (27.5%), ten cases of epidermal inclusion cysts (25.0%), five cases of Gartner's duct cysts (12.5%), one endometrioid cyst (2.5%) and one unclassified cyst (2.5%). Patient age ranged from 20 to 75 years with a mean of 35 years, and a peak incidence between 31-40 years (13 cases, 32.5%). The majority of patients were asymptomatic (31 cases, 77.5%). The cyst type which was more frequently associated with symptoms was Bartholin's duct cyst. Most lesions were located in the left-lateral vaginal wall (13 cases, 32.50%). Mullerian cysts were lined by columnar endocervical-like or cuboidal epithelium, whereas Gartner's duct cysts were all lined by cuboidal epithelium. Epidermal inclusion cysts were lined by stratified non-keratinizing squamous epithelium. Bartholin's duct cysts were lined by transitional, mucin-rich columnar or squamous epithelium and were frequently accompanied by inflammation.

Benign vaginal cysts are in the majority of cases asymptomatic and are often incidentally discovered during gynecological examination for other purposes. The differential diagnosis between Mullerian and Gartner's duct cysts requires histochemical evaluation of epithelial mucin production. The pathogenesis of most types of vaginal cysts remains to be clarified.