usually , gartner 's duct cysts are on the anterolateral vaginal wall and its chances of being present on the posterior vaginal wall are relatively rare .
its incidence of all the vaginal cysts is 12.5% . as it may arise from remnants of wolffian duct
vaginal cyst can be histologically classified as epithelial , inclusion , mullerian , mesonephric , and urothelial in addition to other rare types .
these present with symptoms of visible palpable mass , dyspareunia , voiding disturbances , vaginal discharge , and pain .
a patient , 54-year - old para 4 live 4 , presented herself in the outpatient department of gynaecology , sgrdimsr , amritsar , with chief complaints of mass protruding out from vagina for the last 7 years . on eliciting further history
, she narrated that this mass initially was of lemon size which gradually progressed to the size of orange due to which the patient started having discomfort while changing posture / walking .
she also gave h / o irregular periods for last 2 years with one episode of profuse bleeding with clots for 10 days prior to visit to the hospital .
previous menstrual history was uneventful with menstrual flow of 3 - 4 days/28 days / regular with moderate flow .
p / v revealed a pedunculated posterior vaginal wall cyst with smooth pale pink intact surface lining hanging from middle level with 1.5 cm base protruding out of introitus [ figure 1 ] .
k 90 catheterization in situ , cyst separate from posterior lip of cervix , cyst arising from posterior vaginal wall , and protruding out of introitus polypoidal / rectum ( p / r )  rectal mucosa was free , base of polypoidal cyst was free , and anterior rectal wall was otherwise smooth and normal . on investigations :
hemoglobin 12.4 g% , platelet count 2.9 lacs / cmm , total leukocyte count 6600/cmm , blood urea 24 mg% , serum creatinine 0.7 mg / dl , and cancer antigen 125 - 12 /ml .
tvs  a well - defined cystic mass lesion of 6.5 cm  4.5 cm  3.7 cm protruding out of the vagina .
cyst contained fluid with dense internal echoes with no solid component suggestive of bartholin 's cyst .
right ovary had a well - defined anechoic cyst of 3.8 cm  2.2 cm with no solid component in it .
left ovary was normal and no adnexal mass was seen in the pouch of douglas .
posterior vaginal wall cyst was excised by dissecting posterior vaginal wall from fourchette upward and identifying the base .
stalk was ligated , postvaginal wall cyst was removed , and posterior colpoperineorrhaphy was done [ figures 26 ] .
cervix felt normal , canal was regular , sound was passed up to two and half inches , scanty curettings were obtained , and specimen was sent for histopathological examination ( hpe ) .
excision of posterior vaginal wall from fourchette to the base of cyst repaired vaginal wall p / r : rectal mucosa was found to be intact .
globular cystic skin covered soft tissue piece measuring 5 cm in diameter . on cut section , unilocular cyst is identified filled with thick jelly such as brownish fluid .
photomicrograph showing tall columnar cell lining of cyst wall ( h and e , 100 ) photomicrograph of the same at higher magnification ( h and e , 400 ) postoperative period was uneventful , and the patient was discharged in satisfactory condition .
rare histopathological report has aroused the interest to report this case , as mesonephric duct cysts commonly present in anterior / anterolateral wall only on the rarest occasions if residual tissue of wolffian duct persists , then mesonephric cyst may grow from that abnormal site .
posterior vaginal wall cyst was excised by dissecting posterior vaginal wall from fourchette upward and identifying the base .
stalk was ligated , postvaginal wall cyst was removed , and posterior colpoperineorrhaphy was done [ figures 26 ] .
cervix felt normal , canal was regular , sound was passed up to two and half inches , scanty curettings were obtained , and specimen was sent for histopathological examination ( hpe ) .
excision of posterior vaginal wall from fourchette to the base of cyst repaired vaginal wall p / r : rectal mucosa was found to be intact .
globular cystic skin covered soft tissue piece measuring 5 cm in diameter . on cut section , unilocular cyst
photomicrograph showing tall columnar cell lining of cyst wall ( h and e , 100 ) photomicrograph of the same at higher magnification ( h and e , 400 ) postoperative period was uneventful , and the patient was discharged in satisfactory condition .
rare histopathological report has aroused the interest to report this case , as mesonephric duct cysts commonly present in anterior / anterolateral wall only on the rarest occasions if residual tissue of wolffian duct persists , then mesonephric cyst may grow from that abnormal site .
gartner 's ducts are identified in approximately 25% of all adult women , and nearly 1% evolves into gartner 's duct cysts . during embryological development ,
remnants often remain , however , until they develop a secretory mechanism , cause dilation of surrounding cells , and thus yield a gartner 's duct cyst , most often during and after late adolescence .
classically , the cysts are solitary , unilateral , < 2 cm in diameter , and are located in the anterolateral vaginal wall of the proximal , a third of the vagina .
gartner 's duct cysts are generally asymptomatic and most commonly diagnosed upon routine gynecologic examination , but patients ' complaints can include that of skin tag , dysuria , pressure , itching , dyspareunia , pelvic pain , or protrusion from the vagina if it enlarges to a detectable size , making it a candidate for surgical removal if large enough to cause obstetrical complications , the cyst can be drained to facilitate delivery . to define the course of the gartner 's duct cyst and differentiate it from other pathologic considerations and structures , magnetic resonance imaging can be a useful tool .
histologic examination may be employed to correctly identify the cellular remnants composed of nonmucin secreting low columnar or cuboidal epithelium [ figures 7 and 8 ] .
the differential diagnosis can be included , but is not limited to bartholin 's gland cyst or abscess , prolapsed urethra , prolapsed uterus , vaginal wall inclusion cyst , endometriosis , leiomyoma , sarcoma botryoides , malignant mass , skene 's gland cyst , or abscess and ureterocele . only in exceptionally rare and isolated cases ,
large vaginal wall cysts are always symptomatic which compels the patient to visit a gynecologist .
they mostly present with discomfort with vaginal discharge on and off , dyspareunia , or urinary complaints .
not all patients presenting with mass per vaginum are necessarily a case of uterovaginal prolapse .
 cyst of posterior vaginal wall is very rare . 
 this case relates to a patient who presented with polypoidal mass protruding out from vagina which could have been easily mistaken as uterovaginal prolapse , but appropriate clinical evaluation supported with investigations clinched the diagnosis easily . 
INTRODUCTION
CASE REPORT
Operative procedure and intraoperative findings
DISCUSSION AND CONCLUSION
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Conflicts of interest