Definition/General

Introduction:
-Cervical Nabothian cyst is a common benign retention cyst of the cervix formed by obstruction of endocervical glands
-These cysts result from squamous metaplasia covering endocervical gland openings, trapping mucus within the glands.
Origin:
-Develops from endocervical glands that become obstructed by squamous metaplasia or epithelial overgrowth
-The trapped mucin accumulates within the gland, forming a retention cyst.
Classification:
-WHO Classification categorizes as benign epithelial cyst
-Simple retention cysts with no malignant potential
-Part of normal cervical remodeling process.
Epidemiology:
-Very common in reproductive age women (20-50 years)
-Present in up to 80% of women on detailed examination
-Associated with hormonal changes, pregnancy, and chronic inflammation
-Completely benign.

Clinical Features

Presentation:
-Usually asymptomatic and incidental finding
-May present as palpable cervical nodules
-Multiple cysts common
-Detected on routine pelvic examination.
Symptoms:
-Usually completely asymptomatic
-May cause cervical irregularity on palpation
-No associated bleeding or discharge
-No functional impact.
Risk Factors:
-Reproductive age
-Previous cervical trauma or infection
-Hormonal changes (pregnancy, menopause)
-Chronic cervicitis
-Previous cervical procedures.
Screening:
-Often detected during routine pelvic examination
-Visible on speculum examination as smooth, white-yellow nodules
-Ultrasound may identify larger cysts.

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Gross Description

Appearance:
-Small, smooth, round to oval cysts on cervical surface
-White to yellow coloration
-Soft, fluctuant consistency
-Single or multiple cysts.
Characteristics:
-Size variable (few mm to 2-3 cm)
-Smooth, glistening surface
-White to yellow color
-Soft, cystic consistency
-Contains clear to white mucoid material.
Size Location:
-Located on ectocervix and transformation zone
-Size typically <1 cm but can be larger
-May be solitary or multiple
-Surface or slightly raised.
Multifocality:
-Often multiple cysts present
-Scattered distribution across cervical surface
-May coalesce to form larger cysts
-Bilateral involvement common.

Microscopic Description

Histological Features:
-Cystic spaces lined by single layer of endocervical-type columnar epithelium
-Cyst contains inspissated mucin
-Surrounding stroma shows minimal inflammation.
Cellular Characteristics:
-Lining epithelium: tall columnar cells with basally located nuclei
-Mucin-producing cells with clear cytoplasm
-Minimal nuclear atypia
-Normal maturation.
Architectural Patterns:
-Simple cystic architecture
-Single or multilocular cysts
-Epithelial lining may be attenuated due to distention
-No complex architectural patterns.
Grading Criteria:
-Benign lesion (no grading required)
-Absence of atypia or mitotic activity
-Normal epithelial maturation
-Simple cystic architecture.

Immunohistochemistry

Positive Markers:
-CEA positive in lining epithelium
-CK7 positive
-Mucin stains positive (PAS, mucicarmine)
-Estrogen receptor may be positive.
Negative Markers:
-p16 negative (no HPV association)
-CK20 negative
-TTF-1 negative
-p53 wild-type pattern
-Ki-67 very low.
Diagnostic Utility:
-Usually diagnosis is morphological
-IHC rarely needed
-CEA and mucin stains confirm glandular nature
-p16 negativity excludes dysplastic process.
Molecular Subtypes:
-No specific molecular subtypes
-Benign retention cyst without genomic alterations.

Molecular/Genetic

Genetic Mutations:
-No significant genetic alterations
-Represents mechanical obstruction rather than neoplastic process
-Normal chromosomal complement.
Molecular Markers:
-Normal p53 expression
-Very low Ki-67 proliferation index
-No oncogene activation
-Normal tumor suppressor function.
Prognostic Significance:
-Excellent prognosis
-Completely benign lesion
-No malignant potential
-May resolve spontaneously or persist without complications.
Therapeutic Targets:
-No therapeutic intervention needed
-Mechanical drainage if symptomatic
-No medical therapy required.

Differential Diagnosis

Similar Entities:
-Endocervical polyp
-Cervical cancer (cystic variant)
-Bartholin gland cyst
-Mesonephric cyst
-Paraurethral cyst.
Distinguishing Features:
-Nabothian cyst: Simple cyst, endocervical epithelium
-Polyp: Polypoid architecture, stromal core
-Cancer: Malignant features, invasion.
Diagnostic Challenges:
-Large cysts may mimic neoplasia
-Multiple cysts may cause irregular cervical contour
-Distinction from other cystic lesions.
Rare Variants:
-Giant nabothian cyst
-Infected nabothian cyst
-Multiple confluent cysts.

Sample Pathology Report

Template Format

Sample Pathology Report

Complete Report: This is an example of how the final pathology report should be structured for this condition.

Specimen Information

[specimen type], measuring [size] cm in greatest dimension

Diagnosis

[diagnosis name]

Classification

Classification: [classification system] [grade/type]

Histological Features

Shows [architectural pattern] with [nuclear features] and [mitotic activity]

Size and Extent

Size: [X] cm, extent: [local/regional/metastatic]

Margins

Margins are [involved/uninvolved] with closest margin [X] mm

Lymphovascular Invasion

Lymphovascular invasion: [present/absent]

Lymph Node Status

Lymph nodes: [X] positive out of [X] examined

Special Studies

IHC: [marker]: [result]

Molecular: [test]: [result]

[other study]: [result]

Prognostic Factors

Prognostic factors: [list factors]

Final Diagnosis

Final diagnosis: [complete diagnosis]