A Giant Nabothian Cyst Associated With Secondary Infertility: A Case Report.

Nabothian cysts are common benign retention cysts of the uterine cervix and are usually small, asymptomatic, and incidentally detected. Giant nabothian cysts are rare and may become clinically significant because of mass effect, cervical distortion, symptoms, diagnostic uncertainty, or possible interference with fertility in selected patients. We report the case of a 32-year-old woman with secondary infertility for two years and no significant medical, surgical, or gynecologic history. Before referral, she had not undergone a complete infertility evaluation or detailed per-speculum cervical examination and had waited for spontaneous conception. At our department, speculum examination revealed a large translucent and tense cystic mass occupying almost the entire vaginal cavity and arising from the anterior cervical lip. Pelvic ultrasonography showed a well-circumscribed unilocular anechoic cervical cyst measuring 53 x 50 mm, with regular contours and no solid or complex components. A standard infertility work-up performed after referral was otherwise unremarkable, including ovulation and hormonal assessment, tubal patency evaluation, pelvic ultrasound, and partner semen analysis. The patient was not receiving ovulation induction or hormonal infertility treatment at the time of drainage. Conservative puncture under local anesthesia aspirated 100 mL of viscous mucoid fluid, and a biopsy of the cyst wall was performed. Cytologic examination showed benign endocervical-type epithelial elements without atypia or malignant cells. Histopathologic examination showed mucin-filled cystic spaces lined by benign columnar, cuboidal, or flattened epithelial cells, without cytologic atypia, notable mitotic activity, dysplasia, or malignancy, confirming a nabothian cyst. Clinical and ultrasound follow-up showed resolution of the cyst without recurrence. The patient conceived spontaneously two months after treatment, and the pregnancy resulted in a live birth according to available follow-up. This case highlights a temporal association between conservative treatment of a giant nabothian cyst and subsequent conception, without proving direct causality. Large cervical masses require careful clinical examination, appropriate imaging, broad differential diagnosis including cystic and non-cystic lesions, and cytologic or histopathologic confirmation when diagnostic uncertainty exists.