Giant Nabothian Cyst Mimicking a Huge Cervical Fibroid: Challenging Aspects in Laparoscopic Hysterectomy

Nabothian cysts (NCs) are benign cervical mucous retention cysts, which are usually considered insignificant. A 45 years para 2, presented with lower abdominal heaviness, abnormal uterine bleeding and severe dysmenorrhea for 1 year. On examination, only a part of the anterior cervical lip was visible, and a tense bulging cyst was replacing the posterior lip. The cyst extended supravaginally and filled the posterior fornix. Magnetic resonance imaging suggested a 15 cm × 10 cm huge NC. Laparoscopic hysterectomy was done. There were difficulties in bladder dissection, ureteric identification, and vault delineation. The cyst contained 800 ml of clear fluid with a few milliliters of yellowish mucinous fluid. To our knowledge, NC of this size has not been reported in the literature. NCs are benign lesions, but they have to be differentiated from other cervical cysts - particularly malignant or premalignant lesions. NC can very well be managed laparoscopically, provided the skills of precise dissection are possessed by the surgeon.