診断および治療に難渋したGartner管嚢胞の一例

抄録

  Gartner's duct cysts often occur in the deep and anatomically inaccessible areas of the pelvis and are therefore difficult to diagnose and treat. We report a case of a Gartner's duct cyst that was diagnosed using laparoscopic biopsy and was treated with tetracycline sclerotherapy. A 43-year-old woman was referred to our hospital with lower urinary tract symptoms. Magnetic resonance imaging of the pelvis revealed a multilocular cystic tumor (40 mm×25 mm) between the bladder and the anterior vaginal wall. Image-guided transvaginal fine-needle aspiration was performed, and based on cytological evaluation of the tumor contents, we suspected adenocarcinoma and performed a laparoscopic biopsy for diagnostic confirmation. We used the technique of dissection of the vesicovaginal pouch toward the Aa point, similar to laparoscopic sacral colpopexy and designed an approach for access to the tumor at the anterior vaginal wall. Histopathological evaluation of the resected specimen showed that the tumor wall was covered with flat to cubical epithelium without evidence of malignancy. Immunohistochemical evaluation showed cells with immunopositivity for CK7 and immunonegativity for CK20 and MIB-1 levels <5%. Based on these findings, we confirmed the diagnosis of a Gartner's duct cyst. The cystic fluid re-accumulated after the laparoscopic biopsy, with recurrence of lower urinary tract symptoms. Tetracycline sclerotherapy was performed and led to cyst shrinkage with improvement in the patient's symptoms.

  A laparoscopic approach, specifically a bladder-vaginal detachment procedure performed via laparoscopic sacral colpopexy is useful to treat pelvic floor cystic tumors. Tetracycline sclerotherapy may be useful for conservative management of Gartner's duct cysts or recurrence.