CYSTS of the vagina are rarities, although during the past few years the recorded instances have increased. They are found, ordinarily, as isolated tumors in the mucous membrane or sub-mucosa of the vagina, at times two to three in number, rarely more; Schroeder on one occasion extirpated six at a sitting.
The site is a trifle more frequent on the anterior than on the posterior wall, more rarely on the lateral walls. In one case (Bastelberger) the hymen waa implicated. The size variea between that of pea and a hen's egg, although it may, as in J Veit's case, attain that of a child's head. Very large cysts may implicate the entire length of the vagina, as Nelaton saw on the posterior wall, Cred6 (Htirder's report) on the anterior and J. Veit on the lateral. The contents are at times serous, then gummy, slimy, or emulsion-like, similar to lime (from admixture with cholestea tomatous material), and occasionally blood.
Microscopically, epithelium, granular cells, fat-drops, at times crystals of cholesterine, pus and blood, are found. Exceptionally the clear fluid contains no morphological elements.
In the majority of cases the inner wall of the cyst is lined with cylinder epithelium (Ruge), although laminated epithelium is also found in the same cyst near the cylindrical (Mayer, Lebedeff, Ruge).
The epithelial cyst-wall consists, in superficial cysts, of a thin layer of finely fibrillated connective tissue; in thicker wall cysts there is often a mucous membrane. (Muscular and connective tissue layers, rarely well developed papills3. Ruge, Garrigues.).
A cyst, described by Kaltenbach and examined by Mayer, had a very unusual complicated structure. It resembled a cystoma, a section of which was papillary, and another was glandular in characteristics. In a few instances the epithelial lining was totally wanting (Huguier, Ladreit, Verneuil, Lebedeff).
The anatomic,a1 origin of vaginal cysts has not, as yet, been entirely settled; still, the examinations which have been made point to variations in the local origin. Aside from cysts arising from other sources and growing towards the vaginal wall, the deeper cysts covered by mucous membrane originato from persistent parts of Milller's and Wolff's ducts; the superficial cysts, with simple connective tissue walls covered with cylindrical or laminated epithelium, like those described by von Preusen, although exceptionally, yet they originate from vaginal glands.
In all these instances vaginal cysts have the importance of retention cysts. Blebs has described them as lymphatic cysts in the connective tis sue, lined with endothelium, and possibly formed from dilated lymphatics.
The case of Freund (htematokolpos) and Cullingworth's blood cyst, Smolsky's and Kleinwfichter's cases of pyokolpos unilateralis, and the case of Grafe (from Schroeder's practice), where six cysts lay below one another, the lowest of which projected into the vagina, and were arranged spirally from the right backwards to the left, from the introitus to the for nix, these are instances of development from a remnant of Mailer's ducts, Although the contents of these cysts were varied, serous, slimy, clear and brown, still the wall, a few lines thick, was muscular, and the inner sur face was covered with papillae and cylinder epithelium. Of the same origin, I believe, are two vaginal cysts in new-born infants, the one seen by Winckel and the other by myself.
Winckel saw in a new-born, strongly built infant, a vaginal cyst the size of a cherry, which interfered with micturition. When the child cried a tumor with vascular wall projected through the hymen, between the nymphte. The tumor proved to be a cyst occupying the left side of the anterior vaginal wall, and adherent to the neighboring part of the hymen. He was able to penetrate into the vagina to the right of the tumor. The orifice of the urethra was occluded by the tumor, and the urine was directed to the right and posteriorly over the hymen; the rectum was normal. An incision let out a te-aspoonful of a milky cheesy fluid in which were numerous laminated epithelial cells, fat, bnt no cholesterine. After puncture the urine was passed without difficulty. The meatus urinarius was in its usual place. The cyst shrivelled, and after the twelfth day only a small elevated linear cicatrix was apparent.