Cent. Eur. J. Med. • 5(2) • 2010 • 243-245 DOI: 10.2478/s11536-008-0076-0
Central European Journal of Medicine
Paraurethral cyst: A case report Case Report
Meltem Ceyhan1*, Mehmet Selim Nural1, Tülin Oztas1, İlkay Koray Bayrak1, Riza Rizalar2 1
Department of Radiology, Ondokuzmayis University, Faculty of Medicine, 55139 Samsun, Turkey
2
Department of Pediatric Surgery, Ondokuzmayis University, Faculty of Medicine, 55139 Samsun, Turkey
Received 19 April 2008; Accepted 9 September 2008
Abstract: P araurethral or Skene’s duct cyst is a rare cause of masses located in the inter-labial genitor-urinary region and their etiology is not fully known. These congenital cysts may be diagnosed easily by inspection in the initial physical examination of the new-borne. Radiological evaluation is helpful for differential diagnosis and in determining the proximal extension of the cystic pathology. Treatment alternatives are needle aspiration and non-surgical follow-ups leading to a spontaneous regression and surgery. In this report the radiological findings of a female newborn diagnosed with paraurethral cyst in US and MR examinations have been discussed. Keywords: P araurethral congenital cyst • Newborn’s non-malignant urogenital tumor • Skene’s duct cyst • Ultrasound • MRI
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1. Introduction Paraurethral or Skene’s duct cyst is a very rare congenital anomaly in newborn females. It is considered to occur due to the obstruction of Skene’s duct adjacent to the urethral orifice [1-5]. In this case report, the radiological and surgical findings of a newborn with paraurethral cyst in the interlabial region of the orifice of the vagina are discussed in the light of the medical literature.
2. Case report A two day-old female full-term newborn who was the first child in the second pregnancy of a 28 year-old Turkish mother admitted to OMU Faculty of Medicine with a mass lesion in the orifice of the vagina (Patient ID #: 984091). The delivery was by a cesarean section in full-term and the baby was born 3100 gr. with a good APGAR score. The mother had no history of drug use or smoking, and no x-ray exposure during the pregnancy. No pre-natal screening was noted. A cherry colored mass in the vaginal orifice (inter-labial region) was detected in physical examination (Figure 1). An ultrasound (US)
examination was performed and showed a cystic mass with 17x15 mm size in the inter-labial region posterior to the urethral orifice (Figure 2). Magnetic Resonance Imaging (MRI) revealed a single cyst lied along the urethral region separate from vagina and urethra (Figure 3). Urinary bladder and both kidneys were normal in the radiological imaging. She had immediate surgical intervention with a pre-surgical diagnosis of a paraurethral (Skene’s duct) cyst. After the excision of the cyst, the diagnosis was confirmed histo-pathologically with typical appearances.
3. Discussion Although the etiology of the paraurethral cyst is not fully known, they are believed to occur due to the obstruction of Skene’s duct – adjacent to the urethral orifice – secondary to infections or other causes of inflammatory processes [6]. It is also proposed that the excessive glandular secretions in fetus increased by transplacentally transferred maternal sex hormones may lead to the formation of the cyst [7,8]. The exact incidence is not known, but it is a very rare pathology. For instance,
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Paraurethral cyst: A case report
Figure 1.
The mass in the interlabial region is seen on the midline, posterior to the urethral orifice.
in their case review published in 2007, Fujimota and et al. reported only 49 paraurethral cyst cases presented in the English literature. They have also discussed their 5 paraurethral cyst cases over a 5-year period [9]. These paraurethral cysts spontaneously disappeared within a follow-up period of 3-10 months after birth without any surgical intervention. So far, he suggested non-surgical follow-up on these patients unless no potentially danger of urinary obstruction foreseen. Soyer and et al. have reported two other cases from Turkey most recently and suggested a possible modulating effects of maternal hormones, specifically with estrogens [8]. Actually, the number of the reported cases is estimated to be far less than the real prevalence because of undetected or underreported cases. Figure 3.
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Figure 2.
US examination shows the proximal segment of the cyst is seen to lie between the urethra and vagina. U:Urethra; V:Vagina.
Paraurethral cyst diagnose easily by inspection in the initial physical examination of the new-borne [1,10,11]. It appears in paraurethral region as an ovoid cystic mass with 6-30 mm diameter with typical discoloration. Ectopic uretherocele, urethral prolapsus and most importantly vaginal rhabdomyosarcoma should also be considered for the differential diagnosis [1-4,11]. Ultrasound and MRI is helpful in the diagnosis, in determining the proximal extension of the cyst, in the assessment of urinary obstruction and planning for the correctional surgery. The conclusive diagnosis is confirmed with histopathological examinations after surgery. However, spontaneous resolution has also been reported in paraurethral cysts [2,7,9].
T2-weighted MRI examination. a) The part of the cyst extending to the pelvic area is clearly seen in the sagittal image. b) The position of the cyst posterior to the urethra is shown in the axial image C: Cyst; Black arrow: Urethra.
M. Ceyhan et al.
Needle aspiration and excision have been used in the treatment of paraurethral cysts and they both have been reported to have equal success. In our case, cyst excision was preferred and performed immediately because of the size of the mass and to avoid the obstructive urinary complications. The post surgical period is uneventful and no complication was observed. Microscopic pathological findings are consisted with the presumptive clinical and surgical diagnosis with typical multiply layer epithelial benign cells appearances.
Paraurethral cysts in the newborn should always be considered in the differential diagnosis of the masses located in the interlabial region. As seen in the case presented here, US and MRI examinations are quite helpful in diagnosing the masses located in this region and, if present, defining the concomitant pathologies, and in the planning of the methods of treatment alternatives.
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[7] Wright J.E., Paraurethral (Skene’s duct) cysts in the newborn resolve spontaneously, Pediatr. Surg. Int., 1996, 11, 191-192 [8] Soyer T., Aydemir E., Atmaca E., Paraurethral cysts in female newborns: role of maternal estrogens, J. Pediatr. Adolesc. Gynecol., 2007, 20, 249-251 [9] Fujimoto T., Suwa T., Ishii N., Kabe K., Paraurethral cyst in female newborn: is surgery always advocated? J. Pediatr. Surg., 2007, 42, 400-403 [10] Merlob P., Bahari C., Liban E., Reisner S.H., Cysts of female external genitalia in the newborn infant, Am. J. Obstet. Gynecol., 1978, 13, 607-610 [11] Kimbrough H.M., Vaughan E.D., Skene’s duct cyst in a newborn: case report and review of the literature, J. Urol., 1977, 117, 387-388
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