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Acta Obstétrica e Ginecológica Portuguesa

versão impressa ISSN 1646-5830

Acta Obstet Ginecol Port vol.13 no.1 Coimbra mar. 2019



Large cervical tunnel cluster

Tunnel cluster cervical de grandes dimensões

Pedro Brandão*, Filipa Malheiro**, José Ferreira***

Department of Obstetrics and Gynaecology, Centro Hospitalar São João, Porto, Portugal

*MD, Msc, EFOG; Interno de Formação Específica de Ginecologia e Obstetrícia, Centro Hospitalar Tâmega e Sousa

**MD; Interna de Formação Específica de Ginecologia e Obstetrícia, Centro Hospitalar Universitário São João

***MD; Assistente Hospitalar Graduado de Ginecologia e Obstetrícia, Centro Hospitalar Universitário São João

Endereço para correspondência | Dirección para correspondencia | Correspondence



Nabothian cysts are retention cysts of the uterine cervix, which rarely may appear as multilocular large lesions called tunnel cluster. The authors report a case of a complex pelvic mass with 53x43 mm incidentally detected during a CT exam, initially interpreted as an adnexal mass. At ultrasound there was a big cystic tunnel cluster (type B) of the cervix, with more than 12 loci, the largest with 26 mm, with no vascularisation, occupying the whole cervix, with a multilocular pattern at 3-dimensional ultrasound.

Keywords: Cervix Uteri; Nabothian cyst; Tunnel Cluster; Ultrasonography.


Nabothian cysts, also known as retention cysts of the cervix, are collections of retained mucus at the uterine cervix. It is thought to be a reminiscent of chronic cervicitis1. They are highly prevalent. They are usually asymptomatic, discovered incidentally during gynaecological examination or imagiologic studies of the female pelvis, such as ultrasound, TC or MRI2. Nabothian cysts are usually small, with an average size of 2 - 10 mm but there are anecdotal reports of cysts with up to 80 mm3-6. At ultrasound they appear as anecoid cystic formations inside the cervical tissue. When detected in imaging, the main differential diagnoses are myometrial cysts, vascular structures, adnexal masses or malignancy7. They are benign and require no treatment.

Tunnel clusters are one specific type of Nabothian cysts8. These are multilocular lesions of the cervix, present in 8 percent of female in reproductive age, usually appearing in women with previous vaginal deliveries. They may be non cystic (type A) or cystic (type B)9-11. They are no more than a benign group of dilated endocervical glands. Usually these clusters are smaller than 20 mm and have few loci12.

The authors report a case of a 56-year-old post menopausal woman, nulligravida, in whom a complex pelvic mass with 53x43 mm was incidentally detected during a CT exam because of a gastric adenocarcinoma, apparently arising from the right adnexa (Figure 1).



At gynaecological evaluation, the cervix was big and had an irregular shape with multiple nodules resembling Nabothian cysts. Pap-smear was normal. At transvaginal ultrasound the uterus was anteverted and deviated to the left. The cervix was impossible to define clearly and the cervical canal was not visible. Both adnexal areas were clear and both ovaries had no lesions. There was a big cystic tunnel cluster (type B) of the cervix, with than 12 loci, the biggest with 26 mm, with no vascularisation, occupying the whole cervix (Figure 1). 3-dimensional ultrasound showed a multilocular pattern (Figure 2). Even though all findings suggested a cervical tunnel cluster - a benign condition - a biopsy was undertaken revealing a cyst with an uniform flattened mucinous epithelium without atipia. Given patient’s history of gastric cancer, regular follow-up with 6 months ultrasound and annual pap smear was adopted.



This a case of a large cystic tunnel cluster (type B) of the cervix with several lobules in a nulligravida, incidentally discovered by CT scan and confirmed by transvaginal ultrasound.



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Endereço para correspondência | Dirección para correspondencia | Correspondence

Pedro Brandão



Recebido em: 18/03/2018

Aceite para publicação: 22/09/2018

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