Vagina cyst - Medium Biopsy 1-3 cm

Biopsy

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Histology of vaginal lesion.

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Vaginal Cyst - Medium Biopsy (1-3 cm)

Why is it done?
- Histopathological examination of vaginal cyst tissue to determine the nature and origin of the lesion
- To differentiate between benign lesions (Gartner's duct cysts, Müllerian cysts, epidermoid cysts) and malignant or pre-malignant conditions
- Evaluation of cysts measuring 1-3 cm that persist, enlarge, or cause vaginal symptoms
- To assess for malignancy when imaging findings are inconclusive or clinical suspicion is elevated
- Relief of symptoms including vaginal pressure, discomfort, dyspareunia, or urinary symptoms caused by the cyst
- Tissue obtained during excisional biopsy or cyst removal procedures (1-3 cm size range is ideal for complete histological evaluation)
Normal Range
- Normal Result: Benign cyst with typical histological features of one or more of the following: stratified squamous epithelium, cuboidal/columnar epithelium (Müllerian origin), keratinous debris, or simple epithelial lining without atypia
- Units of Measurement: Specimen size 1-3 cm; histopathological diagnosis described qualitatively
- Negative Result: No evidence of malignancy, dysplasia, or significant inflammation
- Positive Result: Evidence of malignancy, dysplasia, cellular atypia, or significant pathology requiring clinical intervention
- Borderline Findings: Reactive changes, inflammation, or low-grade changes that may require clinical correlation and possible follow-up studies
Interpretation
- Gartner's Duct Cyst: Most common vaginal cyst; lined with cuboidal to columnar epithelium with clear/serous fluid content; benign and typically asymptomatic
- Müllerian Cyst: Lined with simple or stratified epithelium; benign; may arise from remnants of Müllerian ducts
- Epidermoid Cyst: Lined with stratified squamous epithelium containing keratinous material; benign; histology shows keratin production
- Cellular Atypia/Dysplasia: Abnormal cell morphology with increased nuclear-to-cytoplasmic ratio; indicates pre-malignant or malignant potential; requires urgent clinical management
- Squamous Cell Carcinoma: Abnormal keratinized squamous epithelium with invasion; most common vaginal malignancy; often HPV-related
- Adenocarcinoma: Malignant glandular epithelium; includes clear cell and mucinous subtypes; associated with DES exposure or adenosis
- Inflammatory Changes: Increased inflammatory infiltrate, reactive epithelial changes; may indicate infection or irritation; typically benign but requires clinical correlation
- Factors Affecting Results: Specimen adequacy and orientation; presence of intact epithelial lining; tissue fragmentation; contamination; clinical history and imaging findings
Associated Organs
- Primary Organ System: Female reproductive system; vaginal mucosa and submucosa
- Associated Embryologic Origins: Müllerian duct system (paramesonephric ducts), Gartner's duct (mesonephric duct remnants), and primitive mesenchymal tissues
- Commonly Associated Conditions: Benign vaginal cysts (Gartner's, Müllerian, epidermoid); vaginal adenosis; vaginal intraepithelial neoplasia (VIN); squamous cell carcinoma; clear cell adenocarcinoma
- Diseases Detected: Vaginal malignancies; pre-malignant lesions; chronic inflammation or infections; adenosis; cystic anomalies
- Potential Complications: Cyst rupture causing localized irritation; secondary infection; vaginal bleeding or hematoma formation; dyspareunia; urinary obstruction if cyst compresses urethra; psychological distress from malignancy concerns
- Risk Factors for Malignancy: HPV infection; smoking; immunosuppression; prior DES exposure; chronic inflammation; advanced age; prior radiation therapy
Follow-up Tests
- If Benign Findings: Clinical examination at routine annual visits; ultrasound surveillance only if symptoms recur; no additional imaging typically required
- If Dysplasia or Atypia Detected: Colposcopy with potential additional biopsies; HPV testing if not previously performed; imaging studies (MRI/ultrasound) for staging
- If Malignancy Confirmed: Comprehensive staging studies including MRI pelvis, CT imaging, PET-CT as appropriate; gynecologic oncology consultation; HPV testing; immunohistochemistry panels; molecular testing if indicated
- Immunohistochemistry Studies: p16/Ki-67 dual staining for VIN or dysplasia; HPV in-situ hybridization; p53, CK7, CK20 for adenocarcinomas
- HPV Testing: Molecular HPV testing on tissue or follow-up cervical/vaginal samples; high-risk HPV subtypes (16, 18, 31, 33) indicated
- Imaging Follow-up: Transvaginal ultrasound at 3-6 months if incomplete excision; MRI for treatment planning if malignancy; surveillance imaging per oncology protocol
- Clinical Follow-up: Gynecology or gynecologic oncology follow-up within 1-2 weeks; assessment of symptoms; monitoring for recurrence
- Repeat Biopsy: If specimen inadequate, margins involved, or clinical-pathologic discordance; consider repeat sampling in 4-6 weeks
Fasting Required?
- Fasting Required: No
- Patient Preparation: Avoid douching, tampons, and vaginal medications for 24-48 hours prior to procedure; avoid sexual intercourse for 24 hours before; urinate before procedure; wear comfortable, easily removable clothing
- Timing Considerations: Schedule procedure during follicular phase of menstrual cycle if possible; avoid during menstruation; avoid if active vaginal infection is suspected
- Medications: Continue routine medications; do not discontinue anticoagulants or antiplatelet agents without physician consultation; may require temporary discontinuation if heavy bleeding risk
- Anesthesia: Local anesthesia typically used; general anesthesia if extensive procedure planned; fasting requirements apply if general anesthesia anticipated (NPO 6-8 hours)
- Post-Procedure Instructions: Avoid douching, tampons, and intercourse for 1-2 weeks; wear pads for minimal bleeding; avoid strenuous activity for 3-5 days; use ice packs for discomfort; take prescribed antibiotics if provided

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