Nabotinal cysts: what are they?

The internal cervical canal of the cervix is covered with columnar epithelium. The mucous membrane of this canal contains the so-called nabotovy glands, which produce an antibacterial fluid that protects the uterus from disease-causing agents. In some cases, the glandular ducts are "clogged", there is an accumulation of fluid secretions, which leads to the formation of nabotovy cysts - small neoplasms, multiple or single. This pathology is considered quite common. However, the difficulty lies in the fact that most often patients learn about the disease by chance - for example, during a preventive visit to the doctor. [1]

Epidemiology

More than 20% of the fair sex, belonging to the age category from sixteen to 45 years (childbearing age), have certain diseases of the reproductive organs that do not manifest themselves with any pronounced clinical picture or discomfort. One of these pathologies is nabot cysts - they are usually diagnosed in 10% of cases. [2]

Women who have given birth are especially prone to the formation of nabotovye cysts.

Causes nabotovye cysts

Nabotovy glands (also called follicles) look like numerous clusters in the lower segment of the cervical canal. They resemble small tubes filled with a mucous mass. The mouths of the glands are located in the area surrounding the external pharynx. Nabotova cyst is the result of blockage of this orifice, which happens when the evacuation of mucous secretion is disturbed, when it accumulates with simultaneous stretching of the walls of the glandular canal. If one canal suffers, then one nabot cyst is formed, and if several canals are clogged at once, then we are talking about multiple formation of pathology. [3]

What are the reasons for the dysfunction of the glandular canal? The most common reasons are:

• the tissues of the uterine neck are mechanically injured - for example, during abortion, childbirth, instrumental medical or diagnostic procedures;
• there are hormonal disruptions that provoke thickening of the mucous secretion, which entails a worsening of evacuation and blockage of the mouth of the gland;
• an inflammatory process develops, leading to an increase in glandular secretion, thickening of secretions.

Less common causes include cervical endometriosis, a painful condition in which the outlet of the gland becomes clogged with endometrioid tissue. [4]

Risk factors

Risk factors that contribute to the appearance of nabotovye cysts are considered to be the following:

• inflammatory processes in the genitourinary organs, vaginal dysbiosis, HPV;
• structural disorders, age-related changes, dysplasia;
• leukoplakia of the uterine cervix;
• endometriosis;
• genital trauma, childbirth, abortion, curettage, miscarriage, etc.;
• specific infectious lesions (chlamydia, ureaplasma, syphilis, Trichomonas, etc.);
• atrophy of the mucous tissues of the cervix.

Pathogenesis

Nabot cysts can have various origins. They are able to form from unchanged tissue structures, from rudiments, differentiated cells. Some of these neoplasms arise against the background of fluid accumulation in the rudiments of the mesonephral canals localized in the stromal base of the organ, or during the population growth of germ cell structures.

The most common mechanism for the development of nabotovye cysts is squamous metaplasia. Cylindrical epithelial tissue, producing mucous secretions, is replaced by a protective epithelium with a multilayer squamous structure, which often contributes to the overlap of the exits of the cervical glands with their further cystic transformation. In the vast majority of patients, such processes are triggered in ectopic areas, but sometimes they can be observed in the region of the cervical canal, or on a polyposis surface. [5]

With ectopia of the endometrium, the formation of a cavity occurs from structures that are morphologically and functionally similar to the inner surface of the uterus. These structures are implanted in the cervical area. Against the background of cyclic hormonal changes, regular epithelial rejection is noted - as in the body of the uterus, but in endometrioid foci. Also, there is an accumulation of blood mass in them, the formation of cavity cysts.

The Douglas space in women is the lowest localized peritoneal pocket reaching the posterior vaginal wall and lining the anterior rectal surface. It is in this area that many painful reactions are often observed - in particular, endometriosis. The bartholin gland is also prone to frequent formation of cysts, the exits of which are located on both sides of the vagina. Due to the blockage of the output glandular canals, there is an accumulation of secretions, the formation of edema and cystic neoplasms. [6]

Symptoms nabotovye cysts

Nabotovy cysts in the overwhelming majority of cases do not show clear signs of their existence: they are discovered accidentally during examination by a gynecologist.

The first signs may be noted if the patient has large or multiple nabotovy cysts. These signs are:

• dyspareunia (discomfort, pain during sexual intercourse);
• yellowish or profuse mucous vaginal discharge;
• rarely - contact bleeding.

Small, single nabotovy cysts extremely rarely cause pain syndrome: pain can only bother with suppuration of formations. [7]

The presence or absence of symptoms directly depends on the root cause of the appearance of neoplasms. If nabotovy cysts have formed against the background of an infectious and inflammatory process, then a woman often has characteristic symptoms of endocervicitis or colpitis:

• massive serous or purulent-serous discharge, accompanied by an unpleasant odor;
• vaginal burning;
• itching, painful sensations.

Nevertheless, the clinical picture with nabotovy cysts is scanty, or completely absent. That is why, for minor and single cysts, doctors often do not prescribe any treatment, but simply establish dynamic monitoring of the problem.

Nabotov cysts and pregnancy

It is possible to become pregnant with a diagnosis of "nabotovy cysts": in most cases, such neoplasms do not block the cervical canal and do not create obstacles to conception, the flow of the gestation process and the natural birth of a child. However, pregnancy with a nabot cyst differs in some peculiarities and requires additional monitoring by a doctor.

Often nabotovy cysts are found at the stage of pregnancy planning. The primary task of the doctor is to make sure the diagnosis is correct, to exclude hormonal problems, inflammatory and malignant processes in the cervix. Further, the patient is prescribed a comprehensive treatment to eliminate the root causes of the pathology, to strengthen the immune defense, to prepare the female body for the future process of bearing a child.

If surgical treatment is required, then it is carried out before pregnancy. In this case, conception should be planned approximately 6 months after the intervention.

Can there be problems with conception against the background of nabot cysts? Sometimes this is really possible - for example, with numerous or significant cysts that block the lumen of the cervical canal. This makes it difficult for sperm to enter the uterine cavity, and further fertilization becomes impossible.

To prevent such problems, multiple or large nabotovy cysts are removed, carefully choosing the method of intervention. The less tissue is injured during the procedure, the sooner a woman can plan a pregnancy. The most undesirable way to remove cysts, if a woman intends to become pregnant, is instrumental excision of neoplasms. Usually doctors choose more gentle methods - for example, laser treatment or cryodestruction.

Stages

1. Activation of the inflammatory reaction in the vaginal segment of the cervix and in the endocervix.
2. Filling the mouths of the nabotovy glands with particles of squamous epithelium.
3. Clogging of the mouths localized on the mucous tissue.
4. Accumulation of mucous secretions produced by the glands.
5. Dilation of the blocked duct of the gland.
6. Formation of a capsule-shaped cavity filled with mucous secretions.

Forms

Nabot cysts are classified according to the site of localization. According to this classification, neoplasms can be paracervical (located on the vaginal segment of the cervix) and endocervical (located directly in the cervical canal).

In addition, there are single and multiple cysts, small (up to 1 cm) and large (up to 3 cm and more).

By the type of formation and etiological factor, nabotov cysts of the cervix are:

• traumatic;
• infectious and inflammatory;
• dysplastic, dystrophic;
• tumor;
• congenital;
• retention.

Nabotov cysts, cysts of the endocervix, the cervical canal increase due to the accumulation of secretion fluid in them, but not due to an increase in the capsule. Such neoplasms do not belong to genetic or hereditary pathologies, do not pose a danger in terms of infection during sexual intercourse, and are not prone to malignancy. [8]

Nabotov cysts do not affect the ovaries, sometimes accompany cervicitis or cervical ectopia: they are localized exclusively in the area of the uterine neck, more often in the area of the ectocervix. Determination of the type of neoplasm according to the generally accepted classification is necessary to draw up the correct treatment tactics.

Complications and consequences

Nabot cysts can be almost asymptomatic. But if a woman becomes pregnant, then various complications may appear. During the carrying of a baby, pronounced hormonal changes occur in the female body, which can cause the growth and multiplication of the number of nabotovye cysts. These processes, in turn, affect the quality of the cervix: often its walls are deformed, and the lumen is blocked. The situation is aggravated by the fact that with the onset of pregnancy, the vast majority of women lose their immunity. This threatens relapse of inflammatory diseases.

This is why nabotov cysts are dangerous:

• violation of the shape and configuration of the cervix;
• changes in the cervical canal;
• creating favorable conditions for the development of inflammatory processes in the internal genital organs;
• an increase in the likelihood of early termination of pregnancy, or premature birth.

Only a doctor can assess the degree of risk for a particular patient, after an examination and other diagnostic studies. Only after the diagnosis will be determined the treatment strategy and prognosis of the disease. [9]

Diagnostics nabotovye cysts

Diagnosis of such diseases is carried out in the gynecological department, or in an outpatient setting at the reception of a gynecologist. Nabot cysts with visible localization in the cervical region are detected without problems during a standard gynecological examination: the doctor notes the presence of single or multiple dense hemispherical elements of different sizes, with thin walls through which a yellowish secret is visible. If nabotovy cysts are accompanied by an inflammatory process, then reddening of the mucous tissue and their edema are additionally detected. Abnormal vaginal discharge is also present. [10]

Nevertheless, even with a high-quality external visibility of the pathology, additional diagnostic procedures are assigned to each patient:

• Analysis of venous blood for tumor markers (helps to determine the risk of developing malignant processes), general clinical tests of blood and urine (determine anemia, inflammatory processes).
• Instrumental diagnostics includes ultrasound examination of the pelvic organs, magnetic resonance imaging (used to clarify the state of other organs), as well as for differential diagnosis.

With nabotovye cysts, cytology is traditionally used: a smear is taken from the patient's cervix, transferred to the surface of a laboratory glass and examined under a microscope for the presence of atypical cells. In more modern clinical conditions, a new method of liquid cytology (instead of the usual one) is used, followed by analysis for tumor markers.

The differences in liquid cytology lie in the fact that the withdrawn biomaterial is placed in a liquid medium. Further, using centrifugation, smears are formed and transferred to the surface of a laboratory glass. Swabs after centrifugation differ from the usual ones in that they include only "washed" structures, represented by an even concentrated layer. This new method manages to obtain more reliable and informative results than with traditional cytology.

The study of tumor markers practically replaces the previously performed PCR diagnostics for HPV. The sought protein p16ink4α is involved in the mechanism of constant cell renewal of the cervical surface. Its normal concentration indicators are negligible. If the tests indicate an excess of the norm, then the test result for the oncomer is considered positive.

Ultrasound is a well-known method that is indispensable for making this diagnosis. The image obtained during the procedure clearly visualizes the size of the nabotny cysts and their number. The nabotova cyst itself looks like a thickening (focal compaction) of the epithelial tissue of the cervical canal against the background of a small and uneven expansion. If the problem is accompanied by an inflammatory process, then echographically revealed a hypertrophic change and increased echogenicity of the uterus. The ultrasound procedure is quite informative, regardless of the type of its implementation: you can use both an abdominal and a transvaginal sensor. However, specialists themselves often prefer the latter option. [11]

In some cases, ultrasound alone may not be enough: the information should be double-checked using magnetic resonance imaging. MRI is prescribed:

• if there are difficulties in making an accurate diagnosis;
• if clinical manifestations and diagnostic results have certain contradictions;
• if it is necessary to generally find out the condition of the genitourinary organs.

It is optimal to carry out an MRI from the seventh to the thirteenth day of the cycle. [12]

Differential diagnosis

Differential diagnosis is carried out after evaluating all diagnostic results: mirror examination of the cervix, colposcopy, cytological examination, bacterioscopic and bacteriological analysis of vaginal and cervical secretions, examination for STIs, targeted biopsy, local spectroscopy, etc. [13]

Nabot cysts usually have the form of retention neoplasms, the sizes of which vary from 0.2 to 1 cm. The surface of the formations is covered with a different-sized subepithelial vascular network.

Endometriosis of the cervix can manifest itself as subepithelial cysts of a purple hue, with an average diametrical size of 0.3 to 0.7 cm. Among the common symptoms are spotting outside the period of menstruation, contact bleeding.

Uterine fibroids, especially with vaginal prolapse, are easily identified during examination in the mirrors. Some types of fibroids are palpated during bimanual examination. For a more accurate diagnosis, transvaginal ultrasonography is performed, a blood test is taken for hemoglobin and hematocrit (to assess the likelihood of anemia). It is also required to exclude a malignant process by taking a smear for atypical cells from the cervix.

Sometimes nabotovy cysts are found in patients who consulted a doctor with a completely different problem. For example, dyspareunia is often a cause for anxiety in women - this is a painful symptom indicating that a woman has been experiencing pain during sexual intercourse for some time now. As a result, during a clinical examination, the doctor discovers the causes of such discomfort, and in this case, they are nabot cysts.

Since age-related transformations often become the causes of clogging of the glands, involutive changes in the ovaries are also found against the background of nabotovy cysts - this usually happens in women over 40 years of age. In young women, the squamous vaginal epithelium becomes cylindrical in the area of the external pharynx. Over the years, the transition border shifts into the depths of the cervical canal or to the lip of the cervix.

Endocervical cysts also require differentiation. We are talking about benign formations growing in the cervical canal. Such cysts are filled with liquid contents and often develop under the influence of a chronic inflammatory process. They can be found at almost any age, but they are most often diagnosed in patients after childbirth and surgery in the cervical region. The main way to diagnose endocervical cysts is ultrasound.

Cervical dysplasia, or cervical intraepithelial neoplasia, is tissue damage associated with the action of the human papillomavirus. This disease belongs to precancerous and often becomes a precursor of invasive cancer. If dysplasia is suspected, a thorough and complete diagnosis is mandatory.

Another common female disease is oophoritis, which rarely occurs as an independent pathology. Usually, oophoritis develops against the background of other infectious and inflammatory processes - for example, salpingitis, and also has an indirect effect on the further formation of nabot cysts.

Treatment nabotovye cysts

If nabotovy cysts do not cause any pathological symptoms and are not combined with infectious and other diseases, then the patient is registered and dynamic control is established, with background correction of the monthly cycle. However, some doctors give preference to surgical treatment, referring the patient to surgery to remove even uncomplicated neoplasms. There is no consensus on the correctness of such an appointment: this issue is decided on an individual basis.

More information on the treatment of nabotal cysts here .

Prevention

In the process of formation of nabotovy and other cysts, such unfavorable factors as failure of the hypothalamic, pituitary and ovarian regulation of various mechanisms occurring in the female reproductive system play a significant role. Such a failure is often the result of frequent or prolonged stressful situations, infectious diseases, unsatisfactory social, environmental and living conditions. Therefore, the main point of preventing the development of the cystic process can be called the elimination or minimization of the action of these factors.

Menstrual dysfunction is always a reason to visit a doctor. For any irregularities in the monthly cycle in women of childbearing age, it is imperative to perform colposcopy and ultrasound examination of the pelvic organs. This is done in order to timely detect not only tumor processes, but also other pathologies of the female reproductive sphere.

Seeking medical help later may require more complex treatment (including surgery). In addition, the running process increases the risks of recurrence of nabot cysts, and also generally has a negative effect on the patient's reproductive function.

If a woman has already undergone a therapeutic course for a nabot cyst, then in the future she needs to be registered with a dispensary for early prevention of relapse of the disease.

Forecast

The prognosis for nabotovaya cysts can be called favorable. If the disease is not aggravated by complications, then it is most often not accompanied by severe anxiety for a woman, does not affect sexual activity and the ability to conceive.

However, even after surgical removal of such cystic neoplasms, the risk of re-development of the disease remains relatively high. This is due to the impossibility of the absolute elimination of all root causes that contribute to the development of pathology. [14]

If a woman is found to have nabotovy cysts, then, in addition to the main treatment, she needs to undergo regular preventive examinations, with the obligatory colposcopy and bacteriological examination. To prevent recurrence of the disease, such examinations should be carried out annually. But in the event that the disease proceeded with complications, visits to the doctor should be frequent - at least up to two or three times a year.