Naboth's cervical cyst.

A nabothian cyst of the cervix is a benign disease that occurs in women of different ages, but most often in women who have given birth. This diagnosis is often made based on the results of an ultrasound examination, since these formations are often asymptomatic. This is not a serious, life-threatening disease, but it requires treatment and observation. Malignancy of these cysts is usually rare, so you should not worry if such a diagnosis is made. But a woman of childbearing age should be careful, especially when planning a pregnancy.

[ 1 ], [ 2 ], [ 3 ]

Causes nabotic cysts of the cervix

Cysts on the cervix are formed less frequently than cysts in other locations, such as the ovary. This is due to the fact that the structure of the endometrium is typical and there is no great variability of cells, as in the ovary. However, cysts also develop on the endometrium and on the cervix. Nabothian cysts of the cervix are called in honor of the author who discovered the glands inside which the cystic process develops.

Cysts rarely form on unchanged epithelium, since there must be initial structural changes in the structure of the mucous membrane. Nabothian cysts often develop against the background of previously suffered endometriosis, endocervicitis, dysplasia, erosions, infectious colpitis and vulvovaginitis and other diseases of the female genital tract. Any diseases of the cervix or uterus can cause further development of cysts. This is due to the fact that the normal structure of the epithelium of the cervical canal is disrupted and the function of the cells is impaired. Under the influence of hormones, which affect not only the epithelium of the cervical canal, but also the differentiation of all cells and their functional activity, some violations of their function occur, since there are changes in the structure and these cells cannot function normally. Therefore, the secretion of the glands of the epithelium is disrupted, which contributes to the formation of cysts.

Therefore, the main reasons for the development of a nabothian cyst of the cervix can be considered any organic lesions of the cervical canal after injuries, inflammatory processes, on the basis of which disorders of the synthesis of the glands of the secretion that accumulates under the membrane are already developing. One of the conditions is a violation of the hormonal regulation of the ovariomenstrual cycle, in which hormones stimulate the growth of nabothian cysts.

The fact that Nabothian cysts are more common in older women – after 40 years – who have already given birth, confirms the significant place in the etiology of morphological and involutional changes in the epithelium of the cervical canal.

As for the development of nabothian cysts in young women, infectious inflammatory diseases and hormonal imbalances take priority here.

[ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ], [ 9 ]

Pathogenesis

The development of these cysts occurs under the influence of some factors and it is quite difficult to establish the exact moment when the cyst began to develop, since their sizes can be different and their development period is different. But in general, the sizes are often small - a few millimeters and do not exceed two centimeters.

The normal cervix has several zones. The epithelium that covers the vagina and goes over to the cervix is stratified squamous. It secretes a mucous secretion that performs a protective function by eliminating microorganisms and secreting a slightly acidic secretion that prevents further penetration of microorganisms into the cervical canal. Further behind the stratified squamous epithelium is an intermediate zone, which under normal conditions does not have an epithelial cover. Behind the intermediate zone on the side of the cervical canal is a single-layer cylindrical epithelium. This epithelium consists of glands, which are called nabothian, and their main function is to synthesize a secretion that is secreted onto the surface of the cells and protects them and the cervical canal. Since the epithelium is single-row, these glands are located superficially and have the appearance of a honeycomb. This structure and location plays an important role in the development of cysts in this particular place. In certain inflammatory diseases and damage to the columnar epithelium, the secretion outlet from these glands is clogged, and the secretion synthesis continues, which ultimately leads to stretching of the walls of the nabothian gland and the formation of a cyst. These cysts no longer increase in size, since the cyst is retention, not proliferating, therefore, after the formation of cysts, they do not increase.

It is also necessary to differentiate between different types of cysts by quantity, since the tactics of treatment and their observation are different.

Single Nabothian cysts of the cervix are formed if the defect is small and the outflow of only one gland is disrupted. In this case, the wall of the gland is stretched and secretion accumulates there.

Multiple Nabothian cysts of the cervix are more common, since the secretion outflow is often blocked from several glands at once. Such cysts can be located throughout the entire cervix, or they can be concentrated in one place. They are more often symptomatic and have more complications.

[ 10 ], [ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]

Symptoms nabotic cysts of the cervix

The danger of developing these cysts is that they are often asymptomatic, and they are diagnosed only when complications arise. A routine examination in mirrors most often does not show the presence of these cysts, and they are diagnosed only during an ultrasound examination, perhaps even accidentally.

Since nabothian cysts of the cervix are not proliferating, they do not disrupt the normal ovariomenstrual cycle and therefore do not affect the general condition of the woman.

Symptoms of nabothian cysts of the cervix appear when these cysts are already multiple and there is a mechanical obstruction. Then light-colored discharge may appear when the cyst ruptures, they are usually not painful and the woman may not even pay attention to them. The first signs of a nabothian cyst are discomfort and pain during intercourse, as well as discharge, possibly even with bloody or purulent contents when the cysts are infected. These symptoms are not always expressed and depend on the size and number of neoplasms.

Against the background of these cervical cysts, epithelial integrity disorders and subsequent infectious complications may develop. Then, pronounced pain in the lower abdomen, purulent vaginal discharge, and systemic reactions in the form of fever and severe intoxication syndrome may join the clinical symptoms.

Sometimes such cysts are diagnosed during pregnancy and then signs of postpartum septic complications may occur against the background of infection of the cyst. When a nabothian gland cyst develops in an older woman, this may be the cause of further metaplasia of the cervical epithelium, since there are functional changes in the columnar epithelium.

Thus, the course of a nabothian cyst of the cervix is often asymptomatic, which affects further treatment tactics and untimely diagnosis.

[ 16 ]

Nabothian gland cyst of the cervix during pregnancy

Pregnancy is a condition of a woman's body in which all functional reserves must be maximally adapted to the birth of a healthy child. Therefore, pregnancy must be planned, and at the same time, all organs and systems, especially the uterus and ovaries, must be carefully examined. The development of a nabothian cyst in young women is rare, but it can become a serious obstacle to a normal pregnancy and physiological birth.

Often women come with the problem of infertility in marriage, and the cause is difficult to determine. After all the test results, it turns out that the woman is functionally healthy and her hormonal background is sufficient for pregnancy, but this does not happen. Often the only reason for this can be a nabothian cyst of the cervix. This develops due to the fact that there is a mechanical barrier to the movement of sperm, especially if the cysts are multiple - they block the cervix so much that this can be the cause of infertility.

A cyst of the nabothian gland of the cervix during pregnancy also has a number of unfavorable outcomes. If such a cyst is found in a woman during pregnancy, regardless of the period, it must be removed, since it can cause complications during labor itself. The location of the nabothian cyst on the cervix can prevent the normal opening of the cervix in the first stage of labor, and can also cause damage to the cervix when the fetus passes through the birth canal in the second stage. Since these cysts are usually small in size, they do not cause bleeding.

Another complication during pregnancy and childbirth may be suppuration of the cyst contents, and then there is a high risk of developing intrauterine infection of the fetus and the development of postpartum septic complications.

Premature termination of pregnancy can also be initiated by the development of a nabothian cyst on the cervix, which is associated with a disruption in the normal functioning of the epithelium.

Therefore, when diagnosing a nabothian cyst in a pregnant woman, it is recommended to remove it using minimally invasive methods. The treatment method is selected individually, but it is taken into account that the impact on the fetus and the birth canal should be minimal and non-traumatic.

[ 17 ], [ 18 ]

Complications and consequences

Considering the fact that the nabothian cyst of the cervix is asymptomatic in most cases, it is often diagnosed when complications appear. If the cyst is small and single, this process often has a benign stable course without complications. Frequent complications are cyst infection. This occurs when a microorganism gets to the cervix in an ascending manner, and especially with microtraumas of the epithelium, and this causes the development of an infectious process in the gland cavity, where there are good conditions for this. In this case, symptoms of a local inflammatory reaction appear, as well as generalized intoxication manifestations.

Another complication is a rupture of the gland, which is especially dangerous during pregnancy. If a rupture occurs during labor during active contractions, the risk of postpartum trauma to the genital tract increases, as well as postpartum septic complications.

[ 19 ], [ 20 ], [ 21 ]

Diagnostics nabotic cysts of the cervix

Nabothian cysts of the cervix are often diagnosed by chance or when complications arise. A simple consultation with a gynecologist with a mirror examination of the cervix does not always allow a diagnosis to be made, but changes in the cervix often allow one to suspect the development of cysts. Then additional research methods are used to confirm the diagnosis.

The tests that are carried out for the purpose of differential diagnostics do not confirm the diagnosis definitively. A cervical canal smear, which is carried out as a screening test for all women, allows excluding inflammatory diseases and metaplasia of the cervical epithelium. Histological examination of the smear reveals the gland's expansion and deformation with the accumulation of secretion.

General clinical tests – blood and urine tests and bacterial culture from the vagina – do not show any characteristic changes.

The most informative methods that allow confirming a nabothian cyst of the cervix are instrumental research methods.

Colposcopy is an examination of the cervix with a special device that has a magnifying power of several dozen times. Such an examination allows you to examine the cervix and see any changes in the epithelium. In this case, the cylindrical epithelium looks like a mesh of cells with pronounced glands, which has the appearance of a papillary structure. In case of a violation of the outflow of gland secretion, blockage of these glands and areas of their expansion, newly formed cysts are visible. In case of concomitant erosion or other damage, they can also be diagnosed.

Another accurate diagnostic method is ultrasound examination. Cervical cysts look like anechoic formations and their number, size, homogeneity of structure and content can be diagnosed.

These are the main diagnostic methods that allow you to accurately establish a diagnosis and determine the treatment tactics.

[ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ]

Differential diagnosis

Differential diagnostics of nabothian cysts should be carried out with diseases that are accompanied by damage to the epithelium of the cervix. Polyps are a common pathology of the cervix, which externally may resemble cysts, but an ultrasound examination reveals the density of the polyp structure, in contrast to the cyst cavity.

Also, a nabothian cyst must be differentiated from endometriosis - areas of the endometrium with proliferation. Differential diagnostics is carried out on the basis of visual differences, as well as during histological examination of the material.

Treatment nabotic cysts of the cervix

The issue of treating nabothian cysts is quite complex and depends on many factors. Firstly, they do not always need to be treated. The tactics here are as follows: if a woman is young, under 45, and a cyst is detected, then treatment is recommended in order to protect herself in the future. If a woman is over 45 and a cyst is detected that is asymptomatic and up to one centimeter in diameter, then a wait-and-see tactic is followed. As a rule, such cysts do not become malignant, do not grow and do not cause discomfort.

Treatment of nabothian cysts of the cervix can be conservative and surgical. It should be noted that conservative treatment is not of great importance, since such cysts do not have a tendency to spontaneous involution. But the use of various medications can reduce the severity of symptoms and the degree of dysfunction.

There is no huge arsenal of drugs that are used to treat any cysts, but mainly nabothian. This is explained by the fact that there is no reliable data on the degree of cyst reduction under the influence of certain drugs. But symptomatic remedies can be used.

In case of complications in the form of infection, the use of antibacterial therapy is mandatory. Symptomatic anti-inflammatory therapy is used in case of minor local inflammation in case of cyst injury or in case of irritation of the cervix by discharge from a burst cyst. Dicloberl suppositories are used, which relieve swelling, pain and signs of irritation and inflammation.

You can often find treatment with ichthyol ointment. This method has been used for a long time, but it should be said that it is not always effective. Tampons are soaked in ichthyol ointment and placed in the vagina for 10-20 minutes. The effect of this remedy is anti-inflammatory and anti-edematous. In the case of concomitant microflora, an additional effect is created - antimicrobial, which prevents the occurrence of septic complications. But the ointment should not be used in case of cyst rupture, because then the effect of irritation of the mucous membrane is created.

Conservative treatment methods are used, but often as a combination therapy, since these are only symptomatic means that do not affect the development of the cyst itself. If the nabothian cyst of the cervix has a pronounced clinical course, it is better to perform surgical treatment with removal of the lesion and further symptomatic therapy.

Surgical treatment methods are very widely used. This is explained by the fact that there are many minimally invasive technologies that can completely remove a nabothian gland cyst without further risk of complications.

Operative methods include: surgical method, electrocoagulation, cryocoagulation, laser vaporization, radio wave therapy. The main principle of these methods is the complete removal of the cyst. The surgical method involves puncturing the cyst with a needle with aspiration of the contents, which is done for larger cysts and under ultrasound control. This method is quite simple, but slightly invasive and there is a risk of developing infectious complications.

Electrocoagulation, cryocoagulation, laser vaporization, radio wave therapy - this is the use of the physical properties of electric current, liquid nitrogen, laser and radio waves to remove the cyst. These methods are less invasive than puncture, but they are technically more complex and require certain equipment.

The treatment method can be determined individually and depends on many factors, but mainly combined treatment is preferred – surgery followed by symptomatic drug therapy.

It is also necessary to consider whether it is necessary to treat the cyst at all if it is asymptomatic and small in size. In any case, all factors are assessed and tactics are decided.

Treatment of Nabothian cysts of the cervix with folk methods

If the size of the cyst allows not to conduct active treatment, and a wait-and-see approach is chosen, then treatment can be carried out with folk and homeopathic remedies. Herbal treatment can also be carried out in addition to the main methods.

There are many folk medicine methods for treating this condition. The main ones are:

1. Garlic has a pronounced antimicrobial and anti-inflammatory effect, which allows it to be used to treat cysts. To do this, squeeze the juice out of a clove of garlic and mix it with boiled water in a one-to-one ratio, then make a tampon and insert it into the vagina once a day. This can be done for 10 days for no more than 10 minutes.
2. The walnut partitions must be crushed, poured with boiling water and left for 20 minutes, then boiled on the fire for another 10 minutes and allowed to cool. This decoction should be taken orally three times a day, one tablespoon at a time, for at least a week.
3. Burdock juice is excellent for relieving irritation, swelling and has an antiproliferative effect, which increases the ability of the cyst to dissolve. To do this, squeeze the juice out of the pre-washed burdock leaves and take one teaspoon three times a day for five days, and then one teaspoon twice a day for another five days.
4. Acacia shows a good effect in the treatment of nabothian cysts. To prepare the tincture, it is necessary to collect acacia flowers, dry them, pour alcohol and insist in a dark place for at least a day, and then dilute with boiled water and take one tablespoon three times a day. The course of treatment lasts one month.

Homeopathic remedies are also used to treat this pathology. Their main effect is aimed at regulating normal hormonal levels and this promotes the resorption of cysts. The main drugs used are Berberis, Aurum iodicum and Apis. These drugs must also be prescribed in combination therapy.

Prevention

As for the prevention of this disease, there are only non-specific methods. This includes:

• hygiene of sexual life with prevention of genital infections;
• timely treatment of inflammatory and non-inflammatory diseases of the female genital organs;
• annual preventive examination by a gynecologist;
• pregnancy planning with mandatory comprehensive examination of the woman;
• timely treatment of cysts to prevent complications.

These are the main preventive measures not only for this disease, but also for a group of others that are dangerous for women and that can be prevented even before they begin to develop.

[ 28 ], [ 29 ], [ 30 ], [ 31 ], [ 32 ]

Forecast

The prognosis for life of a nabothian cyst of the cervix is favorable, since active growth of the cyst and its malignant transformation are rarely observed. The prognosis for complete recovery is also favorable, since today there are a huge number of different methods of surgical treatment, after which the cyst completely disappears without a tendency to re-form.

[ 33 ], [ 34 ], [ 35 ]