(117) Recurrent Ciliated Vulvar Cyst in a Recently Menarchal 12 Year Old

Background: Cases of cutaneous cysts lined by ciliated epithelium are rare and only a few cases of such cysts in the vulvar vestibule have been reported. Ciliated cyst of the vulva (CCV), though rare, is benign and a variant of ciliated cutaneous cyst. While the etiology is unknown, there have been theories suggesting that these ciliated cysts arise from Mullerian heterotopy, urogenital sinus, or chronic inflammation and obstruction of minor vulvar vestibular glands. Surgical excision should be curative. We present the case of a recently menarchal girl with recurrent CCV.

Case: A 12 year old female presented to clinic for a left recurrent vulvar cyst after resection at an outside facility 20 months prior. The patient expressed vulvar discomfort with crossing her legs and riding a bike or horses, and at times, felt pain independent of activity. She reported thelarche and pubarche at age 11 with thelarche at age 12. Exam showed Tanner III breasts and pubic hair, a 1.5 cm transparent cystic mass on the distal most posterior portion of left labia minora, asymmetry of labia minora with left>right. Operative records from initial procedure were reviewed, revealing a 2 cm left labia minora cyst that was drained and dissected away from surrounding tissues. Specimen described as benign mullerian cyst. A pelvic ultrasound was obtained and was normal. Surgical intervention was requested by patient and family, given discomfort affecting daily activities. She was taken to the OR for an exam under anesthesia, vaginoscopy and excision of labia minora cyst. Vaginoscopy revealed no lesions in the vaginal canal. A vertical incision was marked along the contour of the left labia and cyst wall was identified and mobilized with blunt dissection and pinpoint electrocautery. The cyst was transected with the adherent lateral skin attached to ensure complete resection of cyst with no rupture. The cyst was sent for permanent histopathologic examination. Postoperatively the patient recovered well and met all milestones with no reported recurrence. Pathology revealed the cyst is lined by nonmucinous ciliated cuboidal and low columnar cells.

Comments: The differential diagnosis of benign vulvar cysts in the pediatric population is broad and include Bartholin duct cyst, epidermal inclusion cyst, mucinous/ciliated cyst, canal of Nuck cyst, Gartner duct cyst, or perineal hernia. Only a few cases of CCV have been reported and are generally found in women in their 30-40s. In 11-16 year old girls, there are only 5 reported cases of CCV, most menarchal. We present a case of recurrent CCV with initial removal prior to menarche and recurrence after menarche which, to our knowledge, is the first reported case of recurrence in this population.