Mullerian cysts

Definition: Paramesonephric cyst (or Mullerian cyst) is a congenital cyst arising from paramesonephric remnant (Mullerian remnant).

Mullerian duct cysts are remnants of the embryologic paramesonephric ducts. When remnants persist in the vagina, the patient may present with a cyst, which is usually asymptomatic and @<@ 2.0 cm in diameter.

Paramesonephric cyst occur mostly in the third or fourth decades, after the onste of functional activity with resultant secretory product in the tubal-type of epithelium.

Mullerian duct cysts are commonly small and located in the anterolateral vaginal wall. However, they should be included in the differential diagnosis of any large, protruding vaginal mass (17939605).

When remnants persist in the vagina, the patient may present with a cyst, which is usually asymptomatic and @<@ 2.0 cm in diameter.

Pathology

 Paramesonephric type lesions showed ciliated and microvillous cells, sometimes in a wavy arrangement with grooves and holes, similar to the oviduct epithelium.
 Destruction of specialized surface structures is frequently seen.
 Epithelial proliferation is uncommon.

Paramesonephric duct

The paramesonephric duct (or Mullerian duct) forms the fallopian tube at about 9 weeks of gestation. Multiple invaginations near the ostium of the tube become the fimbriae. Any secondary invagination that does not connect may form a blind sac and enlarge to form a paraovanan cyst.

Types

 unilateral paramesonephric cyst
 bilateral paramesonephric cysts (15683385)

Localization

 In females

• paraovarian paramesonephric cyst
• paratubal paramesonephric cyst
  • uterosacral ligament (9175698)
• vaginal paramesonephric cyst (17939605)
• vulvar paramesonephric cyst
• paramesonephric cyst of the uterosacral ligament

 In males

• paratesticular Mullerian cyst (paratesticular cystic Mullerian remnant)

 In males or females

• retroperitoneal Mullerian cyst

Associations

 46, XYq- chromosome anomaly (7627860)

Complications

 torsion of paramesonephric cyst (1943002, 15683385)
 serous papillary neoplasms arising in paramesonephric cyst (7457096)
 serous cystadenoma of borderline malignancy arising in parovarian paramesonephric cyst (17009641)

Differential diagnosis

 The mesonephric cysts (wolffian cyst) consiste of an epithelium of tightly arranged angular cells with minimally developed surface structures.

See also

 paratubaal cysts
 paramesonephros (Mullerian duct)
  mesonephros (Wolffian duct)

• mesonephric cysts

References

 Prolapsing vaginal cyst: a case report. Kresowik J, Kennedy CM, Wing S, Galask RP. J Reprod Med. 2007 Sep;52(9):852-4. PMID: 17939605

 Serous cystadenoma of borderline malignancy arising in a parovarian paramesonephric cyst. Puig F, Crespo R, Marquina I. Eur J Gynaecol Oncol. 2006;27(4):417-8. PMID: 17009641

 Torsion of bilateral paramesonephric cysts in young girls. Breitowicz B, Wiebe BM, Rudnicki M. Acta Obstet Gynecol Scand. 2005 Feb;84(2):199-200. PMID: 15683385

 Paramesonephric cyst of the uterosacral ligament. Malatyalioğlu E, Kökcü A, Karagöz F, Kandemir B. Eur J Obstet Gynecol Reprod Biol. 1997 May;73(1):105-6. PMID: 9175698

 Müllerian duct cyst with 46, XYq-. Fujisawa M, Okuda Y, Okada H, Matsumoto O, Kamidono S. Int J Urol. 1994 Jun;1(2):195-6. PMID: 7627860

 Torsion of parovarian cyst—report of two cases. Hasuo Y, Higashijima T, Mitamura T. Kurume Med J. 1991;38(1):39-43. PMID: 1943002

 Development and classification of parovarian cysts. An ultrastructural study. Stenbäck F, Kauppila A. Gynecol Obstet Invest. 1981;12(1):1-10. PMID: 7250778

 Serous papillary neoplasms arising in paramesonephric parovarian cysts. A report of eight cases. Honoré LH, O’Hara KE. Acta Obstet Gynecol Scand. 1980;59(6):525-8. PMID: 7457096