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Nabothian Cyst

 
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Nabothian cysts are a normal finding in multiparous women. The usual location is surface of the endocervix where endocervical glands are nromally found. Some may be located deep in the wall and almost reach the outer surface of the cervix or even paracervical soft tissues.

The cysts form when one of the endocervical gland neck gets blocked leading to accumulation of mucus secretions. The patients are asymptomatic or may have symptoms of long-term chronic cervicitis.

The size ranges from 0.2 to 1.0 cm but may be larger (as illustrated in this case). Grossly, they are filled with gelatinous, mucinous secretions. The inner wall may be round and smooth or have irregular, jagged contours. The lining consists of single layer of mucinous columnar or flat epithelium without cytologic atypia or increased mitotic activity.

The main differential diagnosis is minimal deviation adenocarcinoma. Features favoring malignancy include: presence of an obvious mass lesion, gland irregularity, desmoplastic response, cytologic atypia, and increased mitoses.

Image courtesy of: Dr. Ibrahim Zardawi; used with permission.

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