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Gartner Duct Cyst Simplified Treatment Approach
Gartner Duct Cyst Simplified Treatment Approach
DOI 10.1007/s11255-006-9049-x
ORIGINAL PAPER
Abstract We present two patients with Gartners duct cyst managed with simple marsupialization and successful long-term follow up.
Case-1
Introduction
Gartners duct cyst (GDC) is a remnant of the
distal end of the mesonephric duct (Wolffian) in
females. This anomaly is often associated with
other developmental anomalies related to the
mesonephric duct such as an ectopic ureter,
communication with the vagina, and ipsilateral
renal agenesis. Usually the cysts are solitary,
small, but can be large enough to bulge from the
vaginal outlet.
This condition is extremely rare in infants, with
fewer than 40 cases reported in literature [1].
Presentation as a vaginal cyst with an ectopic
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Case-2
A 10-months old girl presented with a history
only significant for chronic constipation and
straining since birth. The child was referred to
urology for the evaluation of a vaginal swelling
discovered by the mother, seen more prominent
during straining.
Examination was remarkable for a bluish tense
cystic mass arising from the vulva, more close to
the right lateral vaginal wall. Urethral meatus was
normal in size and location.
USS revealed a normal left kidney, but the
right one was absent. There was a pelvic cystic
mass posterior to the urinary bladder measuring
6.5 4.5 cm.
DMSA scan confirmed a normally functioning
solitary left kidney and no function in the pelvic
cystic mass.
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Discussion
GDC can be found in the broad ligament, vagina
and the vulva. Patients who present in adult life
typically complain of dyspareunia, disfigurement,
mass filling or fullness in the vagina. If discovered
early in life, usually presents as an external genitalia mass, abdominal pain, vaginal discharge,
recurrent urinary tract infection, incontinence, or
enuresis [2].
The differential diagnosis of an introital mass
in a newborn is GDC, ureterocele, ectopic ureter,
cystocele,
rhabdomyosarcoma,
paravaginal
glands, and urethral diverticulum [3].
There are a few points that suggest the possibility of GDC as opposed to an ureterocele in
patients with ipsilateral renal dysgenesis. The cyst
is retrovesical and bulges into the bladder wall.
The cyst does not communicate with the bladder,
bladder neck or urethra and does not obviously
change in shape and size when intravesical pressure increases with bladder filling and voiding.
The cyst is located on the vaginal wall and may be
connected to the vaginal cavity. The cyst wall is
thick. The ureter emptying into the cyst is small
or normal in caliber [1].
Conclusions
Persistent GDC is a rare condition. It should be
considered when an intrapelvic or retrovesical
mass with ipsilateral renal dysplasia is found. Cyst
marsupialization through the vagina is a simple,
safe, and effective procedure for infants and
children with such diagnosis, and can replace cyst
excision.
References
1. Kalva SP, Rammurti S, Subbarao D, Chittibabu N,
Murthy VS (2001) Small ureterocele-like Gartners duct
cyst associated with ipsilateral renal aplasia: a case report. Australas Radiol 45(1):6263
2. Holmes M, Upadhyay V, Pease P (1999) Gartners
duct cyst with unilateral renal dysplasia presenting as
an introital mass in a newborn. Pediatr Surg Int
15:277279
3. Goldstein AI, Ackerman ES, Woodruff R, Poyas J
(1973) Vaginal and cervical communication with mesonephric duct remnants: relationship to unilateral renal
agenesis. Am J Obstet Gynecol 116(1):101105
4. Currarino G (1982) Single vaginal ectopic ureter and
Gartners duct cyst with ipsilateral renal hypoplasia and
dysplasia (or agenesis). J Urol 128(5):988993
5. Sheih CP, Li Y, Liao YJ, Chiang CD (1996) Small
ureterocele-like Gartners duct cyst associated with
ipsilateral renal dysgenesis: Report of 2 cases. J Clin
Ultrasound 24:533535
6. Sheih CP, Li YW, Liao YJ, Huang TS, Kao SP, Chen
WJ (1998) Diagnosing the combination of renal dysgenesis, Gartners duct cyst and ipsilateral Mullerian
duct obstruction. J Urol 159:217221
7. Abd-Rabbo MS, Atta MA (1991) Aspiration and tetracycline sclerotherapy: a novel method for management of vaginal and vulval Gartner cysts. Int J Gynecol
Obstet 35:235237
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