A suspicious vulvar mass diagnosed as a subpubic cartilaginous cyst

Retropubic parasymphyseal cyst: A rare entity

We report a case of a retropubic parasymphyseal cyst in a 69-year-old multiparous female with a protracted history of metastatic small bowel carcinoid (neuroendocrine) tumor. Cysts related to the pubic symphysis are uncommon, and mostly reported in subpubic location. They may be confused with primary vulvar masses, malignant bone tumors or metastatic disease. In our case, encapsulation, lack of solid components or diffusion restriction, communication with the symphysis, lack of activity on Gallium-68-Dotatate PET/CT and signal characteristics on MRI similar to those previously reported in literature for subpubic cysts all aided in eventual diagnosis. We aim to remind the reader of this rare entity and its distinguishing features on imaging.

Subpubic cartilaginous cyst: an unusual cause of urinary tract infection

It is important to consider alternative causes when treating refractory cases of urinary tract infection in the elderly population.

Subacute Urinary Retention due to a Subpubic Cartilaginous Cyst Treated with Surgical Resection and Internal Fixation: A Case Report and Review of the Literature

A subpubic cartilaginous cyst is a rare mass lesion derived from the pubic symphysis, which can cause acute or subacute urinary retention. We report a case of a subpubic cartilaginous cyst in a 62-year-old woman that caused lower abdominal pain and subacute urinary retention, requiring surgical resection. On physical examination, a hard, flexible, nontender mass, 4 cm in diameter, was palpable along the lower border of the pubic bone, extending to the perineum. Magnetic resonance imaging revealed a clearly distinct (3.8 cm × 3.8 cm × 7.2 cm) mass on the midpelvic side of the pelvis, centered on the pubic joint. We proceeded with en bloc resection of the mass, including a resection margin of 1 cm on either side. The bony defect was fixed with a locking plate. On pathological assessment, the mass was diagnosed as a subpubic cartilaginous cyst arising from the cartilage of the pubic symphysis. No tumor recurrence was identified over a 4-year follow-up. Based on our experience, we propose that en bloc resection of the mass, including a wider resection centered on the pubic symphysis, with internal fixation, is a possible treatment for a subpubic cartilaginous cystic mass lesion.

Complete spontaneous regression of a subpubic cartilaginous cyst: a case report

Subpubic cartilaginous cyst was recently reported as a rare degenerative mass on the pubic symphysis. We report here a 59-year-old woman who presented with a vulvar mass that showed complete spontaneous regression 48 months after the initial visit. Treatment was only wearing brace. This is the first report of complete spontaneous regression of a subpubic cartilaginous cyst. In the case of small subpubic cyst, observation and follow-up alone may be sufficient. J. Med. Invest. 63: 319-322, August, 2016.

Sonographic appearance of a cartilaginous cyst from the symphysis pubis mimicking a mass in the urinary bladder

A suprapubic cartilaginous cyst from the symphysis pubis is a rare lesion, which may be asymptomatic or cause symptoms such as urinary retention and pelvic pain. It is thought to be secondary to degenerative changes in the symphysis pubis and usually occurs in multiparous women. We report the case of a suprapubic cartilaginous cyst in a 76-year-old asymptomatic woman, which mimicked a bladder mass on ultrasonography.

Subpubic cartilaginous pseudocyst: orthopedic feature with urological consequences

Introduction. Masses arising from structures adjacent to the female urethra can cause obstructive urinary symptoms. Subpubic cartilaginous pseudocyst is a rare degenerative lesion of pubic symphysis that may cause these symptoms. Materials and Methods. A 61-year- and 57-year-old women presented with symptoms of difficult micturition and dyspareunia. Physical examination revealed a painless smooth, rounded, firm, and cystic mass, at the anterior vaginal wall of about 4 cm width. The mass caused inward deviation of the external urethral meatus. Cystoscopy and MRI were done. Results. Cystoscopy of case 1 (61 y) demonstrated anterior external urethral compression with normal urethral mucosa. Cystoscopy was not possible in case 2 (57 y) because the urethra could not be entered under local anesthesia. MRI showed almost the same findings in both cases: midline, rounded, and cystic mass ~3 × 3 × 4 cm, anterosuperior to the urethra, and posteroinferior to the pubic symphysis, with normal features of the urinary bladder. Open surgical excision of theses lesions was performed in both patients. Histopathologic assessment of the specimen obtained from both patients showed degenerated hyaline with areas of fibrinous and mucoid degeneration, a picture suggestive of cartilaginous subpubic pseudocyst. After 11-month and 4-month followup of patients numbers 1 and 2, respectively, there is no evidence of local recurrence of the lesion, either clinically or radiologically and both patients void empty. Conclusions. Subpubic cartilaginous pseudocysts are rare benign lesions with only 13 cases were reported in the literature. Patients present with a spectrum of gynecological and/or urological manifestations. Sizable lesions severely compressing the urethra need surgical excision to restore the voiding function.

Surgical approach to a vulval-pubic cartilaginous cyst: A case report and review of published work

Cartilaginous cyst of symphysis pubis is rare and to our knowledge 12 cases have been reported in the published work. Although cartilaginous cysts of the vulva and pubis are likely to present to a gynecologist as a vulval-pubic mass, their diagnosis and management warrants a multidisciplinary team approach because of their rarity and anatomical location. Non-invasive diagnosis includes magnetic resonance imaging and ultrasound scan, while the invasive preoperative biopsy is reserved for cases with a high index of suspicion of malignancy. The surgical approach for the management of vulval-pubic cartilaginous cyst is not well established. The current case demonstrates a joint surgical approach involving a gynecologist and orthopedic surgeon in management of a degenerative cartilaginous cyst. As this condition is benign, every effort should be made to preserve the stability of the pubic symphysis. Symphyseal dysfunction from surgery remains a potential complication for which treatment is not straightforward.

Suprapubic cartilaginous cyst - A case report

Suprapubic cartilaginous cyst (SPCC) is a rare condition known to occur in postmenopausal multiparous women. It is due to the degeneration of the pubic symphysis. Due to its slow progression and rarity in occurrence, it is often misdiagnosed. Presentation includes a painless mass in the suprapubic region, urinary retention, recurrent urinary tract infections, dysuria and dyspareunia. Knowledge of this condition is of great importance, as this is a benign condition that is managed conservatively, thereby avoiding unnecessary procedures. Surgical resection has not shown to have any additional benefit. Once suspected, MRI is ideal for diagnosis. This case report discusses a SPCC with punctuate calcifications and a locule of gas within it. This is the first documented case of a SPCC with punctuate calcifications.

Sub-pubic cartilaginous cyst--diagnostic utility of CT-guided contrast injection

Sub-pubic cartilaginous cyst is an unusual, non-neoplastic, cystic lesion arising secondary to degenerative change in the symphysis pubis and usually is seen in multiparous women. Only a few case reports have been published describing the pathological findings and characteristic MRI appearances of the lesion. This report is the first to illustrate the diagnostic utility of CT-guided contrast injection into the cyst to diagnose this benign lesion. This is a simple procedure which can provide the diagnosis accurately and help to prevent excessive morbidity from wide local excision of what may be assumed to be a sarcoma.

Cartilaginous symphysis pubis cysts: report of two cases, technique for removal, and review of the literature

Cartilaginous symphysis pubis cysts are rare. There are 7 cases previously reported in the literature. Patients are commonly asymptomatic or may present with a slow-growing, painless vulvar mass, voiding difficulty, and/or dyspareunia. Two cases were managed at our center over 5 years. We present these 2 cases, a surgical technique for removal, a summary of all reported cases, and some perspectives on the pathophysiologic mechanisms for the origin of this lesion.