Cysts
These are common, usually asymptomatic subepithelial cysts occurring in the vestibule [1].
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Cysts David Nunns and Rosalind Simpson
13.1 Mucinous Cysts of the Vestibule and Medial Labia Minora These are common, usually asymptomatic subepithelial cysts occurring in the vestibule [1]. They are of variable sizes and usually solitary lesions that are skin colored, red, and yellow or occasionally have a bluish tinge. The cysts are lined histologically by mucinous epithelium and are of interest as they are derived from the urogenital sinus embryologically [2] (Fig. 13.1). No treatment is needed, and patients can be reassured, unless they become big or located in the clitoris area (Figs. 13.2, 13.3, 13.4, and 13.5).
13.2 E pidermal Cyst (Epidermoid Cyst; Epithelial Cyst) These are the commonest skin cysts occurring on vulva and usually develop in hair-bearing areas (Figs. 13.6, 13.7, 13.8, and 13.9).
D. Nunns (*) Department of Gynaecological Oncology, Nottingham University Hospital, Nottingham, UK R. Simpson Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK e-mail: [email protected]
Fig. 13.1 Mucinous cyst of the vestibule. Courtesy of Professor Jacob Bornstein
The cause is unknown but may be iatrogenic following surgery or blockage of the pilosebaceous unit. Histologically, epidermoid cysts are lined by stratified squamous epithelium and are filled with keratin to produce lesions that clinically contain a white content.
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_13
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D. Nunns and R. Simpson
Fig. 13.4 Excision of the clitorial cyst. Courtesy of Professor Jacob Bornstein
Fig. 13.2 Mucinous cyst in the clitorial area. Courtesy of Professor Jacob Bornstein
Fig. 13.3 Excision of the clitorial cyst. Courtesy of Professor Jacob Bornstein
Fig. 13.5 The cyst enucleated from the clitoris. Courtesy of Professor Jacob Bornstein
They are usually asymptomatic, but some patients may complain that they are unsightly or irritating. Some reported cases have involved the clitoral hood to give the impression of clitoromegaly [3]. Infected cysts are painful and can discharge pus.
They can vary in size from 1–2 mm (often called milia) to several cm and also color (skin colored to clinically obvious yellow nodules). A biopsy is not usually necessary, and management depends on symptoms. Asymptomatic
13 Cysts
Fig. 13.6 Epidermal cysts: skin colored nodules. Courtesy of Professor Jacob Bornstein
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Fig. 13.9 Epidermal cysts: skin colored nodules. Courtesy of Professor Jacob Bornstein
lesions can be managed expectantly, while other lesions can be locally excised.
13.3 B artholin Gland Cyst, Abscess, and Tumor
Fig. 13.7 Epidermal cysts: skin colored nodules. Courtesy of Professor Jacob Bornstein
Fig. 13.8 Epidermal cysts: skin colored nodules. Courtesy of Professor Jacob Bornstein
There are two Bartholin glands situated within the labia majora on both sides, with their ducts open to the vestibule at 4 and 8 o’clock. They have the function of producing m
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