Nuck Cyst, an Unexpected Amethyst Gem in the Inguinal Canal: A Case Report and Literature Review

Nuck cyst is rare female saccular hydroceles. It appears at birth or months or years later in adulthood, resulting from imperfect closure of the canal of Nuck. Its diagnosis is often incorrect and confused with an inguinal or femoral hernia because of its extreme rarity. Consequently, surgery often leads to intraoperative surprises. We aim to increase knowledge and awareness of this rare pathology to improve the differential diagnosis of female inguinal masses that have been present for several years and to avoid intraoperative surprises. Therefore, with this study we want to highlight the diagnostic and surgical context of this rare pathology of adult women.

We report the case of a 42-year-old woman who came to our attention for swelling and right inguinal pain that had been worsening for over ten years. Intraoperative abdominal ultrasound reported the presence of a hernia defect and the presence of a hypoechoic mass of uncertain nature, probably of lymph node type. The intraoperative diagnosis of a Nuck cyst was histologically confirmed. The patient underwent Nuck cyst removal and right inguinal hernioalloplasty.

The patient was discharged without any complications the same evening of surgery intervention. At the 10-day postoperative check-up, she reported the disappearance of all preoperative symptoms. Subsequently, we reviewed the currently available literature on different diagnostic and surgical approaches to treat this pathology. Our surgical approach gave postoperative results consistent with those reported in the literature.

Nuck cyst is a rare pathology that should always be suspected in women with decades of inguinal pain. It requires an accurate preoperative diagnosis for a perfect surgical removal intervention.