What is Nabothian Cyst?

Nabothian cysts, also known as mucinous retention cysts or epithelial cysts, are a common and harmless condition that often occurs in women of childbearing age. They are not usually significant for your health. These cysts are found at a specific junction in the cervix, which is often the area from where samples are taken during cervical screening tests. These cysts are filled with mucus, but can also contain protein matter, white blood cells or remnants of white blood cells. They are usually seen near the surface of the cervix and can be easily spotted during a special examination called a colposcopy.

In rare cases, if there are many cysts or if they are large and situated deeper in the cervix, they can make the cervix larger than usual, which might lead to symptoms. These large cysts could also be caused by other conditions like degeneration of a type of uterine tumor called a leiomyoma, birth-related uterine cysts such as mesonephric and paramesonephric cysts, or a condition called cystic adenomyosis.

What Causes Nabothian Cyst?

The surface layer of the cervix, called the squamous epithelium, can multiply and end up covering the columnar epithelium, another type of cell layer found in the endocervical glands, the part of the cervix closest to the uterus. This usually happens when the cervix is inflamed for a long time—a condition known as chronic cervicitis—either as a response to heal or as part of a natural cell-change process known as physiological metaplasia.

The columnar epithelium produces a substance called mucus, which can form retention cysts or nabothian cysts. While these cysts are usually tiny and only a few millimeters across, they can sometimes grow to 4 cm or even larger.

Risk Factors and Frequency for Nabothian Cyst

Nabothian cysts are not often studied, making them less understood when compared to other conditions. However, a Florida hospital conducted a research in 2010 and 2011, examining more than 2,118 uterus removal surgeries. In this study, they discovered that about 3% of these cases had a type of nabothian cyst called a hemorrhagic nabothian cyst.

Signs and Symptoms of Nabothian Cyst

Nabothian cysts are often discovered by accident during routine pelvic examinations and usually cause no symptoms. However, large cysts can sometimes be more complex, resembling serious conditions like cancer or tumors. Symptoms of larger Nabothian cysts might include:

Pain during sexual intercourse (dyspareunia)
Pelvic pain
Irregular vaginal bleeding
Vaginal discharge
Discomfort caused by the cyst pressing onto another organ, such as:
- Abnormal bowel movements and a constant urge to defecate (if pressing onto the rectum)
- Difficulty urinating (urinary retention)
Unexplained stoppage of menstruation (amenorrhea)
Lower abdominal pain

Testing for Nabothian Cyst

If your doctor suspects that you may have nabothian cysts, which are tiny cysts that develop on the surface of your cervix, they might recommend tests like transvaginal ultrasound or magnetic resonance imaging (MRI). These tests can help confirm the diagnosis. An MRI in particular can distinguish between different types of growth, and between normal and abnormal conditions. On an MRI image, a nabothian cyst typically appears as a high-intensity mark, meaning it stands out clearly.

If there’s a concern that the cyst might be cancerous and the MRI doesn’t provide a clear enough answer, your doctor might need to perform other procedures to confirm the diagnosis. These could include a biopsy, in which a small piece of tissue is removed and tested for cancer; a conization, where a cone-shaped piece of tissue is removed from your cervix for examination; or an endocervical curettage, where the lining of the cervical canal is scraped away and examined under a microscope.

Unfortunately, even with these advanced diagnosing methods, if the cysts are unusually large and deep within the cervix and cancer cannot be ruled out, surgery might still be necessary. Options can include exploratory laparotomy, a surgery that allows the doctor to look directly at the organs in the abdomen, or hysterectomy, a surgery to remove the uterus.

Treatment Options for Nabothian Cyst

Nabothian cysts are usually harmless and do not need treatment if they are not causing any symptoms and there is no risk of cancer. However, if these cysts are causing discomfort or the risk of cancer cannot be ruled out, it may be necessary to treat them. The typical treatment involves draining the cyst. But, it’s important to note that one of the disadvantages of this procedure could be the formation of scar tissue, which could cause pain in the future.

Now, suppose a woman is about to give birth and has Nabothian cysts that are blocking the birth canal. In that case, the same method of draining the cyst can be used to help facilitate a normal vaginal birth. However, if it is difficult to make a diagnosis, or if the cysts are deep or particularly large and causing symptoms, then it might be necessary to remove the cysts surgically. This step also allows doctors to study the removed tissue under a microscope to rule out other possible issues, like cervical tumors or a specific type of cancer known as adenoma malignum.

Adenoma malignum, a unique type of adenocarcinoma with multiple cysts, and malignant glandular cervical lesions can often appear like Nabothian cysts. However, these malignant lesions are usually found deeper in the cervix. Another condition to consider is endocervical adenocarcinoma, which can also have a significant cystic component.

Other conditions to keep in mind, which are non-cancerous growths in the cervix, include:

Leiomyomas
Endometriosis
Micro-glandular hyperplasia
Squamous papilloma
Mesonephric duct remnants

What to expect with Nabothian Cyst

Nabothian cysts are harmless and typically don’t cause concern for doctors. They are quite small, usually around 0.2-0.3 cm in diameter. In some cases, they can grow larger than 1 cm, but it’s very rare for them to exceed 4 cm in size.

Possible Complications When Diagnosed with Nabothian Cyst

Nabothian cysts may cause a variety of complications. These include a pooling of menstrual blood in the uterus (known as hematometra), difficulties during labor due to blocked pathways, abnormal bleeding from the uterus specifically when the cyst is greatly oversized, and ongoing issues with emptying the bladder caused by restricting the bladder’s outlet or by pressing against nerve pathways that aid the bladder. These pathways are known as the pudendal and sacral nerves and any disruption in their function can interfere with the detrusor muscle, which helps control urination.

Also, in medical imaging studies involving the use of iodine -131 to scan the whole body, mistaken iodine uptake from nabothian cysts in the uterus were often spotted. This frequently leads to a false-positive result. To accurately identify nabothian cysts in such scenarios, Magnetic Resonance Imaging (MRI) can be utilized.

Potential Complications:

Hematometra (menstrual blood pooling in the uterus)
Labor passage obstruction
Abnormal uterine bleeding
Chronic urinary retention
False-positive iodine uptake in diagnostic scans

Preventing Nabothian Cyst

Nabothian cysts are harmless and are often found during gynecological examinations. However, they can sometimes appear as a large lump. If the cyst is big and buried deep within the tissue, it must be entirely removed. This is necessary to rule out the possibility that the cyst is malignant or cancerous.