Cervix
Benign / nonneoplastic epithelial lesions
Nabothian cysts
Author: Gulisa Turashvili, M.D., Ph.D.
Editorial Board Member: Carlos Parra-Herran, M.D.
Deputy Editor-in-Chief: Jennifer A. Bennett, M.D.
Last author update: 1 February 2021
Last staff update: 4 April 2022
Copyright: 2007-2024, PathologyOutlines.com, Inc.
PubMed Search: Nabothian cysts cervix
Table of Contents
Definition / general | Essential features | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Clinical images | Gross description | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Virtual slides | Cytology description | Positive stains | Negative stains | Sample pathology report | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1 | Board review style question #2 | Board review style answer #2Cite this page: Turashvili G. Nabothian cysts. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixnabothiancyst.html. Accessed April 24th, 2024.
Definition / general
- Variably shaped, cystically dilated benign endocervical glands
Essential features
- Most common type of cervical cyst
- Benign finding, typically incidental, not requiring treatment
- May be associated with tunnel clusters
- Deep or large cysts may mimic malignancy on imaging
Epidemiology
- Common, representing the most common type of cervical cyst
- Typically incidental
Sites
- Transformation zone of cervix
Etiology
- Cyst formation may be related to obstruction of endocervical gland opening due to inflammation or squamous metaplasia (Mayo Clin Proc 2011;86:147)
- Symptomatic nabothian cysts may occur as a late complication of subtotal hysterectomy due to internalization of the transformation zone and partial obliteration of the cervical canal (J Reprod Med 1999;44:567)
Clinical features
- Usually asymptomatic
- Large cysts may be symptomatic or present with vaginal discharge (Radiographics 2005;25:3)
Diagnosis
- Microscopic examination
Radiology description
- Deep or large cysts may mimic malignancy on imaging (J Med Ultrasound 2018;26:153)
- Deep cysts need to be distinguished from well differentiated gastric type adenocarcinoma (minimal deviation adenocarcinoma)
- Magnetic resonance imaging:
- Nonenhancing well circumscribed single or multiple round or oval cysts with a smooth wall, in contrast to well differentiated gastric type adenocarcinoma (minimal deviation adenocarcinoma), which shows enhancing irregular branching cysts with rough and fine granules (Magn Reson Imaging 2004;22:1333)
- Small cysts with well defined margins showing iso to hypointense or rarely hyperintense signal relative to muscle on T1 weighted images, hyperintense on T2 weighted images (Radiographics 2003;23:425)
- Ultrasonography (AJR Am J Roentgenol 1982;138:927):
- Anechoic well defined cystic lesions near the endocervical canal
- Large cysts may be associated with enlargement of the cervical region
- No associated color flow on color Doppler
- Computed tomography:
- Usually seen as a focal low attenuation region
- Small cysts may not be detected
- Nabothian cysts have been described to cause false positive iodine uptake (Clin Nucl Med 2014;39:680)
Radiology images
Images hosted on other servers:
Nabothian cysts on computed tomography
Prognostic factors
- Excellent prognosis
Case reports
- 32 year old woman with nabothian cyst content and high grade squamous intraepithelial lesion in cervical liquid based cytology preparation (Diagn Cytopathol 2019;47:127)
- 46 year old woman with a large nabothian cyst causing chronic urinary retention (Medicine (Baltimore) 2020;99:e19035)
- 52 year old woman presenting with uterine prolapse (Clin Med Insights Case Rep 2020;13:1179547620974676)
- 52 year old woman with a giant cystic mass of the cervix (Clin Exp Obstet Gynecol 2017;44:326)
Treatment
- Not required
- Sometimes excision may be performed in large complex cystic lesions raising the differential diagnosis of gastric type endocervical adenocarcinoma
Clinical images
Images hosted on other servers:
Multiple nabothian cysts
Nabothian cyst
Gross description
- Single or multiple yellow-white mucin filled cysts usually measuring up to 1.5 cm, rarely reaching 4 cm
- Occasionally, cervical enlargement (Mayo Clin Proc 2011;86:147)
Gross images
Images hosted on other servers:
Nabothian cysts
Microscopic (histologic) description
- Single or multiple dilated mucin filled cysts lined by a single layer of columnar, cuboidal to flat cells with variable amounts of mucinous cytoplasm and small, basal, round to oval nuclei with fine chromatin, lacking nucleoli and mitotic activity
- May rupture with extravasation of mucin into stroma and reactive changes
- May penetrate deeply into cervical wall
- May be associated with tunnel clusters (Am J Surg Pathol 1990;14:895)
Microscopic (histologic) images
Contributed by Gulisa Turashvili, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Cystically dilated glands
Bland epithelial lining
Endocervical polyp with nabothian cysts
Virtual slides
Images hosted on other servers:
Nabothian cysts and microglandular hyperplasia
Deep nabothian cysts
and tunnel clusters
(right: PAS-Alcian blue stain)
Cytology description
- Nabothian cyst content (granular material) may be mistaken for tumor diathesis in liquid based preparations (Diagn Cytopathol 2019;47:127)
Positive stains
- PAX8
- PAX2 (Am J Surg Pathol 2010;34:137)
- CEA (luminal)
- Mucicarmine
- PAS-Alcian blue (purple staining of acid mucin typical of normal endocervix)
Negative stains
- HIK1083 (Mod Pathol 2004;17:962)
- GATA3
- Ki67: low proliferation index
Sample pathology report
- Nabothian cysts are generally not mentioned in the pathology report, unless there was clinical / radiological concern of a malignant process.
Differential diagnosis
- Type B tunnel clusters:
- Well demarcated, round, lobular proliferation of cystically dilated glands containing insipissated mucin
- Well differentiated gastric type adenocarcinoma / minimal deviation adenocarcinoma:
Additional references
Board review style question #1
Which malignant entity has the greatest morphologic overlap with multiple deep nabothian cysts?
- Clear cell carcinoma
- Endometrioid adenocarcinoma with mucinous differentiation
- Mesonephric adenocarcinoma
- Well differentiated gastric type adenocarcinoma (minimal deviation adenocarcinoma)
- Usual type endocervical adenocarcinoma
Board review style answer #1
D. Well differentiated gastric type adenocarcinoma (minimal deviation adenocarcinoma)
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Board review style question #2
Which of the following statements is true for nabothian cyst?
- Nabothian cyst is a nonobligate precursor of gastric type adenocarcinoma
- Nabothian cyst is a benign finding not requiring treatment
- Multiple nabothian cysts are associated with increased risk of well differentiated gastric type adenocarcinoma (minimal deviation adenocarcinoma)
- Multiple nabothian cysts are more common in endometrial endometrioid adenocarcinoma with mucinous differentiation
- Multiple nabothian cysts are often associated with Peutz-Jeghers syndrome
Board review style answer #2
B. Nabothian cyst is a benign finding not requiring treatment
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