Saturday, October 25, 2014

Definition

An inclusion cyst is a small encapsulated fluid filled structure due to embryonal or traumatic implantation of epithelium (tissue composed of contiguous cells with a minimum of intercellular substance) into another structure. Inclusion cysts are the most common cystic structures in the vagina.

Description

Several types of benign cysts can develop in the vagina. The most common are inclusion cysts and Gartner duct cysts.

While inclusion cysts are caused by trauma - after an operation or childbirth (the vaginal walls may not heal to perfect smoothness). Gartner duct cysts are vestiges of a duct that serves a purpose before birth and then disappears. Sometimes a Gartner cyst enlarges enough to poke through the vaginal opening.

Inclusion cysts, small cysts occurring at the lower end of the vagina and usually on the posterior surface, arise from inclusion beneath the surface of tags of mucosa resulting from perineal lacerations or from imperfect approximation in the course of surgical repair of the perineum, usually at episiotomy. Occasionally, such cysts are found at the apex of the vagina after hysterectomy in the region of the scar. They are lined by a stratified squamous epithelium, and the content is usually cheesy.

The usual location is in the superficial mucosa. A characteristic finding is thick, cheesy contents on cut section. A prominent basement membrane is often present with smooth muscle being absent from the cyst wall. Inclusion cysts are usually situated within the lower posterior or lateral vaginal wall, at sites of previous episiotomy.

Treatment

The majority of inclusion cysts are asymptomatic. One may elect to ignore a vaginal cyst. If it causes discomfort such as pain or dyspareunia (pain in labial, vaginal, or pelvic areas during or after intercourse), a cyst can be removed surgically. If it is small enough, it can be removed in a physician's office with local anesthesia.

Questions

Where is the cyst located?

What is its size and will it grow larger?

Is a biopsy necessary to rule out a diagnosis of cancer?

What caused the cyst?

What treatment do you recommend?

What will happen if nothing is done?

Is surgery advised?

What are the benefits and risks of surgery?

Can surgery be performed as an outpatient procedure?