Cervical Nabothian Cyst

A nabothian cyst is a retention cyst of the cervical glands, formed when squamous epithelium covers the opening of an endocervical crypt and mucus collects behind it.

• It is a normal finding in women of reproductive age, especially after childbirth or cervical inflammation.
• It is benign and needs no treatment.
• Multiple, irregular or deep cysts need exclusion of a mucinous adenocarcinoma.

Usually no symptoms.

• Smooth, round, translucent or yellow-white nodules 2 mm to 3 cm on the ectocervix, often several.
• A large cyst gives a feeling of pressure, discharge or distortion of the cervix on examination.
• Differential diagnosis: cervical polyp, cervical fibroid, cervical endometriosis, adenoma malignum (minimal deviation adenocarcinoma), cervical cancer, Gartner duct cyst.
• Complications: rarely infection, cervical enlargement and obstruction of the cervical canal.

Diagnosis is by speculum examination, with imaging or biopsy for atypical cysts.

• Speculum examination.
• Cervical cytology, HPV test or VIA.
• Transvaginal ultrasound to show an anechoic cyst when it is large or the cervix is bulky.
• MRI of the cervix and biopsy when cysts are multiple, deep, solid or irregular, or when the cervix is enlarged.
• Endocervical swab for infection if discharge or cervicitis is present.

Reassure, since asymptomatic cysts need no treatment.

• Supportive: reassure that the finding is normal and harmless; no change in lifestyle is needed.
• Pharmacological: none for asymptomatic cysts. Treat cervicitis if present: ceftriaxone 500 mg IM single dose plus doxycycline 100 mg oral 12-hourly for 7 days.
• Procedures: none for asymptomatic cysts. Large symptomatic cysts: puncture with a fine needle or incision, or electrocautery, in the outpatient clinic. Biopsy or cone excision when the cyst is irregular or atypical.
• Special groups: in pregnancy leave the cysts alone; do not puncture.
• Red flags: multiple or deep cysts with an enlarged cervix and watery discharge, irregular cervical surface, bleeding, positive screening test.
• Follow-up: routine cervical screening; review in 6 months if cysts are changing.