Search

While Bartholin gland abscesses are less commonly seen outpatient pathology, prompt diagnosis and treatment are essential to preventing serious complications such as sepsis and rectovaginal fistula. Owing to an unacceptably high recurrence rate, simple incision and drainage is insufficient for primary treatment; preferably, placement of a Word catheter or Jacobi ring device to reepithelize the duct may be done under local anesthesia in an outpatient clinic. Destruction of the gland through silver nitrate application or alcohol sclerotherapy is an alternative. Marsupialization is often reserved for recurrent cases, although can be offered as primary management in some situations.

Introduction Bartholin gland cysts or abscesses account for many gynecologic visits in the emergency department (ED). Previous smaller studies have suggested a link between Bartholin cysts/abscesses and sexually transmitted infections (STIs), but few studies have involved the ED. Methods We retrospectively identified patients aged 18 years or older seen in 1 ED between January 2012 and March 2017 who had urinalysis and urine culture and/or were tested for gonorrhea, chlamydia, or trichomonas by nucleic acid amplification testing. Univariate and multivariate analyses were used to evaluate associations between Bartholin cysts/abscess and demographics, laboratory findings, and ED diagnoses. Results Data were collected for 75,000 ED patients; 64 patients had a diagnosis of Bartholin cyst or abscess, 40 of whom were also tested for Neisseria gonorrhoeae or Chlamydia trachomatis. Ten percent of patients with a Bartholin cyst/abscess were infected with N gonorrhoeae, compared with 3% of those without a Bartholin cyst/abscess (P = .008). The rates of C trachomatis and Trichomonas vaginalis infections were 13% and 26%, respectively, among patients with a Bartholin cyst/abscess, compared with 8% and 30%, respectively, among those without a Bartholin cyst/abscess (P > .05 for both). On regression analysis, only increased urobilinogen level (β, 0.31; odds ratio, 1.36; 95% CI, 1.11–1.66; P = .003) and infection with N gonorrhoeae (β, 1.69; odds ratio, 5.40; 95% CI, 1.43–20.35; P = .01) were associated with a Bartholin cyst/abscess. Conclusions Clinicians in the ED should consider testing patients with a Bartholin cyst/abscess for gonorrhea.

Objective To present a case of vulvar myoma and the factors differentiating this tumor from Bartholin's cyst. Case report A 50-year-old woman presented with a nodule over the left labia majora. Pelvic examination showed swelling and redness of the left labia majora. A 2-cm nodule with firm consistency was found near the vaginal opening. There was no inguinal lymphadenopathy. Bartholin's cyst was suggested, and oral cephalexin was prescribed for 1 week, but no improvement was seen. Therefore, she underwent excision of the nodule. Pathology revealed it to be a benign vulvar myoma. The patient recovered well, and no recurrence was noted after 2 months of follow-up. Conclusion Vulvar myoma is rare. Sexual history, nodule consistency, and imaging are helpful, but the final diagnosis of vulvar myoma is usually made following surgical excision and histopathological analysis.

Bartholin’s gland was first identified in human female in 1675 by Caspar Bartholin. The Bartholin gland is composed of several epithelial types: The body is mucinous acini, the duct is predominantly transitional epithelium, and the orifice is the squamous epithelium. Primary carcinoma of the bartholin’s gland is an uncommon neoplasm. Adenoid cystic carcinoma (ACC) of bartholin gland carcinom is a rare variant of bartholin gland carcinoma, comprising 15% of all bartholin gland malignancies. ACC of the Bartholin’s gland is characterized by slow growth so recurrence and distant metastases can take a long period. So distant metastasis has been found in only a few cases to the lungs, liver, bone and brain. Here, we present the case of Bartholin’s gland ACC after four years follow up and presented with a lung metastasis.

Background Small cell neuroendocrine carcinoma of the Bartholin gland is an extremely uncommon gynecologic tumor. Brain metastasis from a malignant gynecologic lesion is rarely encountered and the prognosis for this type of metastasis is quite poor. Case Description We report a case of a brain metastasis from a small cell neuroendocrine carcinoma of the Bartholin gland that was treated by surgical resection followed by whole-brain radiation therapy and review the literature. Conclusions Different treatment options, including resection, stereotactic radiosurgery, and whole-brain radiation therapy, as well as chemotherapy, are available and should each be considered on an individual basis.

Nodular hyperplasia of the Bartholin's gland is an underreported and extremely rare entity that presents as a solid lesion potentially raising concern for malignancy clinically, most solid lesions at this location are carcinomas. They may also be mistaken for a Bartholin cyst clinically. Nodular hyperplasia is rarer than carcinoma of the Bartholin gland, and hence pathologists may not be familiar with this entity, making it a pitfall in pathologic as well as a clinical diagnosis. Here we report a case originally considered a Bartholin cyst, but raising intraoperative concern due to solid elements. Histological examination of the lesion revealed nodular hyperplasia of Bartholin's gland. Recognition of this entity is important, as it is something that may be encountered by the pathologist.

Background In this case report we present a case of endometriosis in the Bartholin gland without surgery in the perineal area. So far, only five cases concerning endometriosis in the Bartholin gland, which may or may not be an isolated finding, have been reported in the literature. Case presentation A 31-year-old Indo-surinamese woman with primary infertility presented at our out-patient clinic with cyclical vulvar pain. On gynecological examination, a cyst of 1 × 2 cm was found in the right gland of Bartholin. A transvaginal ultrasound revealed normal gynecological anatomy and did not reveal any contributing information. Due to the recurring pain of the cyst, surgery was scheduled. During surgery, the marsupialization of the cyst resulted in drainage of a chocolate-colored fluid. Pathological examination revealed stroma lined with non-typical columnar epithelium with hemosiderin pigments, which confirmed a diagnosis of endometriosis in the Bartholin gland. Conclusion Our findings revealed a case of endometriosis outside the pelvis, without any deep intraperitoneal involvement. So far, only five cases concerning endometriosis in the Bartholin gland, which may or may not be an isolated finding, have been reported in literature.

Highlights • This entity has pathological characteristics identical to mucinous colorectal carcinoma. • KRAS mutations are observed in approximately 40% of colorectal cancers. • The treatment and management may not differ from that of squamous cell carcinomas., Purpose To report a case of intestinal-type adenocarcinoma of the Bartholin gland treated successfully with surgery and to review the current literature. Methods We report the case of a 45-year-old white woman with intestinal-type adenocarcinoma of the Bartholin gland treated with wide local excision followed by bilateral inguinal femoral lymph node dissection without adjuvant therapy. We also review the literature on the treatment and management of this rare tumor. We searched Pubmed / MEDLINE databases for previous case reports or series using the keywords “Bartholin gland”, “adenocarcinoma” and “intestinal type”. Results We found 19 cases of intestinal-type adenocarcinoma of the Bartholin gland published up to November 2020. The treatments described varied from case to case. Conclusion Intestinal-type adenocarcinoma of the Bartholin gland has been treated and managed in the same way as squamous carcinoma. Treatment of these cancers is understudied and involves local resection with curative intent. More case reports are needed to determine the best treatment strategies.

Bartholin gland carcinomas are rare forms of vulvar malignancy and it is unclear what proportion is associated with high-risk human papilloma virus (HPV) infection. Our hospital archives were searched for all cases of Bartholin gland carcinoma from 1984 to 2017 (n=16). We excluded 3 adenoid cystic carcinomas, which were the subject of a previous study, leaving 13 cases. We reviewed all slides and performed immunostains for p16 as a surrogate biomarker for high-risk HPV. There were 12 squamous cell carcinomas (SCCs), including 1 SCC with transitional-like morphology and 1 papillary SCC, and 1 adenocarcinoma. All SCCs showed diffuse and intense p16 expression consistent with the presence of HPV. The single case of poorly differentiated adenocarcinoma showed patchy staining. Patient age ranged from 38 to 72 yr (mean, 58.3 yr). Most tumors were low stage. All patients were treated with radical vulvectomy and inguinofemoral lymphadenectomy. Mean clinical follow-up was 53.7 mo (range, 3-181 mo), 9 patients were free of disease (75%), recurrence occurred in 3 cases, with death due to disease in 2 of the patients with recurrence, including the single patient with adenocarcinoma. All SCC of Bartholin gland expressed p16 diffusely and intensely regardless of histologic features and grade. Our results support the etiologic role of HPV in the pathogenesis of SCC of Bartholin gland. In this small study we observed SCC as the predominant histotype, and most tumors presented at early stage and were associated with relatively favorable outcomes.

Primary adenocarcinoma of the vulva is a rare disease, and usually arises in a Bartholin gland or occurs in association with Paget’s disease. Furthermore, adenocarcinoma of intestinal type of the vulva is an extremely rare neoplasm, and few cases have been reported. The appropriate treatment for optimal prognosis is unclear. We report a case of adenocarcinoma of intestinal type of the vulva occurring in a 63-year-old female. The tumor was found near the urethra, and biopsy specimen showed a proliferation of signet ring cells embedded in an abundant myxoid stroma and irregular tubular structures of atypical columnar epithelium. An extensive workup showed no metastases. Local excision with a 2-cm lesion in the vulva side, bilateral superficial inguinal lymph node dissection and Cloquet lymph node biopsy were performed. Cancer cells contained mucinous materials in the cytoplasm, which exhibited diffuse positive staining for cytokeratin 20 and CDX2. The final pathologic diagnosis was adenocarcinoma of intestinal type of the vulva (pT1bN0M0). The patient received adjuvant external irradiation because of positive urethral surgical margin. She is well 1 year after therapy. Immunohistochemical staining for cytokeratin 20 and polyclonal CDX2 is helpful with investigation of adenocarcinoma of intestinal type, but long-term prognosis remains unclear.

Nodular hyperplasia (NH) of the Bartholin gland is an exceedingly rare benign solid lesion of the female genital tract that can mimic the Bartholin gland cyst clinically. The histologic criteria for NH were established in 1998 by Koenig and Tavassoli. In this case series, we describe 4 cases of NH from Women and Infants Hospital in Rhode Island. All cases have microscopic features of lobular proliferation of acini and inspissated mucin. One case especially has extensive mucin extravasation mimicking an aggressive angiomyxoma. In this case series, we call attention to NH as another entity to consider in the differential diagnosis of an enlarged Bartholin gland. We also discuss ways to distinguish it from other benign and malignant solid lesions of the vulvar vestibule.

Melanocytic pigmentation occurs in multiple sites in the lower female genital tract, but is rare within benign cysts of the vulva. We report 3 patients with multiloculated cystic lesions of the vulvar vestibule exhibiting prominent melanocytic pigmentation. The current cases differ from a previous report of melanosis in a Bartholin gland cyst in that the population of melanocytes occupies the acinar structures of the gland, rather than a squamous-lined surface. A similar cell population is demonstrated by immunoperoxidase methods in a fourth patient's nonpigmented gland, suggesting that melanin production may arise in a native, rather than metaplastic, cell population.

Bartholin gland carcinoma is a rare tumor that constitutes 2-7% of all vulvar cancers. We presented a 40-years-old multipara who presented to the outpatient Gynecologic clinic of the JFK Maternity Hospital with a complaint of painful vulvar swelling of 3 years duration. The swelling began as a small lump on the left labium majus and grew overtime becoming increasingly painful, ulcerated with associated bleeding and malodorous discharge. Her last sexual activity was 2 years ago, of which she experienced dyspareunia but no post coital bleeding. Vulva examination revealed an ulcerated fungating lesion involving the left labium majus and minus, firm, tender, extending 2 cm into left vaginal wall and lower aspect of the right labium minus. The diagnosis of Bartholin gland carcinoma was made with Bartholin gland abscess and Vulvar cancer as differentials. Preoperative Fine Needle biopsy (FNA) showed acute on chronic inflammation of the Bartholin gland. A left hemivulvectomy was done and specimen was sent for histology, which revealed locally invasive squamous cell carcinoma of the Bartholin gland. Patient recovery was uneventful and she was discharged home 2 weeks post operatively on supplements and advised to follow up for chemotherapy.

Worldwide, the most common cause of genital trauma is obstetric injury that usually occurs during vaginal deliveries. Nonobstetric vulvar and vaginal trauma is relatively uncommon due to their anatomic location. Such trauma includes blunt injuries, consensual and nonconsensual intercourse, female genital mutilation, and, less commonly, burn injuries. The extent of the injuries varies from minor bruising and lacerations that may not require any medical or surgical interventions to severe life-threatening complications requiring emergent care. Bartholin gland disorders are common conditions affecting women most commonly in their reproductive age. Establishing the proper diagnosis allows for adequate management, which can vary depending on the clinical conditions and risk of recurrence. Bartholin gland disorders should be distinguished from vulvar abscesses that have a different pathogenesis and treatment. Although very rare, pain out of proportion to exam findings should raise the suspicion for necrotizing fasciitis.

We report a case of clear cell hidradenoma of the perineum that was initially misinterpreted as a papillary urothelial carcinoma, either metastatic or of Bartholin gland origin, on initial excisional biopsy. The misinterpretation may have been due to the pseudopapillary architecture and GATA3-positivity of the biopsy tissue. Clear cell hidradenomas often show a range of histologic growth patterns and cellular differentiation and are one of many tumors that react immunohistochemically with GATA3. Although rare, these tumors can occur in the genital region and can mimic malignant tumors such as metastatic renal cell carcinoma and carcinomas of the genitourinary tract. This report details the morphologic and immunohistochemical pitfalls that make accurate diagnosis of clear cell hidradenoma in this unusual location challenging.

Approximately half of adenocarcinomas that involve the vulva are secondary, either through direct extension or metastases from elsewhere. Primary vulvar adenocarcinomas are rare and encompass a diverse array of neoplasms that are nominally classified based on the presumed tissue or organ of origin, the tumoral phenotype, or both. In this review, we summarize the clinicopathologic features of adenocarcinomas that originate from the vulva and related structures, including the terminal urethra. Adenocarcinomas of this region encompass lesions that are defined by their primary site (such as adenocarcinomas of the Bartholin gland, which by definition must be in the region of the Bartholin gland), histomorphology and immunophenotype (such as clear cell carcinoma and adenocarcinoma of intestinal [cloacogenic] type), or both (such as adenocarcinoma of skene gland origin, which is associated with that specific organ but which also displays a distinctive phenotype that is similar to the phenotype of high grade prostatic adenocarcinoma). Other types, such as mammary-type adenocarcinomas, are presumed to originate from the putative mammary-like glands of the vulva and display a spectrum of pathologic features that are similar to their mammary counterparts. Similarly, vulvar carcinomas of sweat gland origin are pathologically similar to their counterparts in the non-vulvar skin and include a variety of cutaneous adnexal-type malignancies such as apocrine adenocarcinoma and eccrine adenocarcinoma. Some tumors, such as adenoid cystic carcinoma, may represent a Bartholin gland adenocarcinoma, a carcinoma of sweat gland origin, or a carcinoma arising from extramammary Paget disease (EMPD), depending on the context. Invasive carcinomas of various types have been reported in 7-12.7% of EMPD, and these are likely the most common primary glandular malignancy of the vulva. Occasional vulvar adenocarcinomas have been reported to be HPV-associated, although this association has not been established for the broader group of vulvar adenocarcinomas. Rare adenocarcinomas are not classifiable by the aforementioned nosologic scheme, and are designated as vulvar adenocarcinoma NOS.

TitleBartholin’s Gland Cyst or Abscess: A Novel Surgical Treatment Using a Looped Packing Strip: a case reportAuthorDavid W. Hobson, MD, American Board of Obstetrics and Gynecology, Fellow American College of Obstetricians and GynecologistsDepartment of Obstetrics and Gynecology, Spring Branch Community Health Center, Houston TexasCorrespondenceSpring Branch Community Health Center 800 West Sam Houston Parkway South Suite 200 Houston Texas 77042-1914 Email: dhobson@sbchc.netCommentsThis case report is submitted to BJOG An International Journal of Obstetrics and Gynaecology in response to the paper written by Illingworth BJG, Stocking K, Showell M, Kirk E, Duffy JMN. Evaluation of treatments for Bartholin’s cyst or abscess: a systematic review. BJOG 2020;127:671-678.Illustrations(Figures)TitleBartholin’s Gland Cyst or Abscess: A Novel Surgical Treatment using a Looped Packing Strip: a case reportKeywords: Bartholin’s Cyst, Bartholin’s Abscess, Word Catheter, case report, packing stripAbstractThis is the first reported surgical treatment of a Bartholin’s cyst under local anesthesia using a looped plain packing strip passed through two incisions of the Bartholin’s cyst or abscess, loosely tied and left in place four to six weeks creating a permanent fistula. The potential advantages of this procedure include: 1) ease of use 2) low cost 3) lower risk for recurrences 4) requires minimal training 5) alternative choice in patients who would like to avoid the use of a catheter and other more invasive treatments 6) use in cysts smaller than 2 cm in size.IntroductionThe Bartholin’s gland produces mucoid secretions that provide lubrication of the distal vagina and labia minora. The Bartholin’s duct commonly becomes obstructed leading to the formation of a cyst or abscess. This affects about 2% of women mostly of reproductive age11Omole F, Simmons DJ, Hacker Y. Management of Bartholin’s duct cyst and gland abscess. Am Fam Physician 2003;68:135-40. Patients often complain of pain in the vulva when sitting, walking and during intercourse. They are seen in many clinical settings such as emergency rooms, outpatient clinics and Doctors’ offices. Treatments have included aspiration, incision and drainage, packing the abscess, insertion of catheters, rings, silver nitrate gland ablation, marsupialization, sclerotherapy, resection of the gland,and carbon dioxide laser procedures. Systematic reviews22Illingworth BJG, Stocking K, Showell M, Kirk E, Duffy JMN. Evaluation of treatments for Bartholin’s cyst or abscess: a systematic review. BJOG 2020;127:671-678 have not identified the best approach. Currently, placement of the Word catheter under local anesthesia is the favored procedure.33Krose JA, van der Velde M, Morssink LP, Zafarmand MH, Geomini P, van Kesteren P, et al. Word catheter and marsupialization in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomized clinical trial. BJOG 2017:124:243-9. However the use of the Word catheter has several limitations such as: 1) balloon loss reported as high as 43%, 244Reif, P, Ulrich D, Bjelic-Radisic V, Hausler M, Schnedl-Lampprecht E, Tamussino K. Management of Bartholin’s cyst and abscess using the Word catheter: implemenatation, recurrence, rates and costs. Eur J Obstet Gynecol Reprod Biol 2015;190:81-84 2) technical challenges such as catheter leak, deflation, inflating the catheter with a needle larger than 24 gauge, failure to direct the needle into the lumen of the catheter, failure to maintain pressure on the syringe plunger as you remove the needle from the inflated catheter, and vulvar pain from the inflated catheter,55Mellick L. A word about Word Catheters. 2012 Aug 1. Available from: https://journals.lww.com/em_news/pages/blogs.aspx 3) recurrences of the cyst or abscess ranging from 4-17%66Wechter ME, Wu JM, Marzano D, Haefner H. Management of Bartholin duct cysts and abscesses. A systematic review.Obstet Gynecol Surv 2009;64:395-404. Figure 1. Bartholin’s cysts with open ostiaThe WoMan-trial (Word versus Marsupialization) was a randomized clinical trial that compared treatment of a Bartholin’s cyst or abscess under local or no anesthesia to marsupialization performed under spinal or general anesthesia. The recurrence of a cyst or abscess, median time for recurrence, and postoperative pain scores after 24 hours were not significantly different between the two groups. Kroese et al concluded that that treatment using a Word catheter was a faster, lower cost alternative, and relieved pain sooner after diagnosis compared to marsupialization.3Randomized clinical trials to date have not identified the best treatment of a Bartholin’s cyst or abscess. The best approach will be the development of a novel intervention with devices that are smaller in size, more comfortable, remains in place four to six weeks, and creates a permanent fistula.2Materials and MethodsA 45 year old female was seen in our clinic during the period of May 2018 through May 2020 by the author. Written informed consent was obtained for treatment and publication. There was no financial or other incentive for participation. There were no sources of support and no conflicts of interest. She complained of a six year history of swelling in the right labia minora. Physical examination confirmed a 4 cm right Bartholin’s cyst. One week later she presented with a 6 cm right and 4 cm left Bartholin’s cyst. Both cysts were incised and drained. She had recurrence of both cysts documented on visit day 15. On visit day 15, the right Bartholin’s cyst was incised, drained with placement of the looped packing strip. The left Bartholin’s cyst was 4 cm and not drained. The packing strip was removed 11 days later. The second recurrence of the right Bartholin’s cyst was 10 days after removal of the packing strip. On visit day 36 she had a 4cm right Bartholin’s and 10 cm left Bartholin’s cyst. Both Bartholin cysts were incised, drained, and treated with insertion of bilateral packing strips that remained in place for 32 days. Incision and drainage consisted of a sterile prep using povidone iodine 10% solution, local anesthesia using Lidocaine 1% 3ml, 25 gauge 5/8 inch needles, with injections into the labial skin overlying the cyst 1-2 cm outside of the introitus, and making one 5 mm stab incision with a no. 11 blade scalpel. The insertion of the packing strip consisted of making two 5 mm stab incisions with a no. 11 blade scalpel through the skin and cyst wall, under local anesthesia, one at the top and bottom edges of the cyst 1-2 cm lateral to the introitus. The tip of a curved hemostat was inserted into the lower incision passing through the upper incision. A ½ inch x 15 cm length plain packing strip was pulled through both incisions and loosely tied using a square knot. Allowance was made to avoid tension on the skin. The extra packing strip was cut close to the knot. Postoperative instructions included twice daily cleansing with a gentle wash and returning to the clinic in 4-6 weeks for removal of the packing strip.ResultsThe patient was contacted by telephone and agreed to come in for evaluation. Informed consent was obtained for publication. The patient was seen by the author in our clinic 1.72 years after placement of the looped plain strips that remained in place for 32 days. Examination confirmed that both Bartholin cysts were draining mucoid secretions through two ostia. (fig.1)DiscussionThis case report demonstrates how the treatment with incision and drainage alone and removal of the packing strip 11 days after insertion resulted in the recurrence of a right Bartholin’s cyst. Treatment using packing strip left in place for 32 days resulted in the creation of permanent fistulas. Both cysts were noted to drain through created ostia seen 1.72 years after removal of the looped plain packing strip. The primary outcome measure in the treatment of a Bartholin’s cyst or abscess is the creation of a permanent fistula. The preferred treatment of a Bartholin’s cyst or abscess should be fast, safe, performed in an outpatient setting under local anesthesia, heal rapidly without complication, and have low recurrence.2 This procedure requires minimal training, is cost effective, and well tolerated by this patient. The novel placement of the looped packing strip in this patient with bilateral recurrent Bartholin’s cysts accomplished this goal. Further research is needed to compare placement of the looped packing strip versus insertion of the Word catheter.Disclosure of interests: there were no financial, personal, political, intellectual or religious interestsContribution to authorship: there is only one author David W. Hobson, MDPatient’s consent: consent for evaluation, treatment, procedures and publication was obtained in writingFunding: none requiredReferences

Background Bartholin gland carcinomas (BGCs) are rare tumor types, for which no molecular analyses including genomic sequencing have been reported to date. Adenoid cystic carcinomas (ACCs) of the Bartholin’s glands are an atypical histological type of BGC, and currently nothing is known regarding their genetic profiles or similarity to ACC carcinogenesis in other organs including the salivary glands, thereby limiting possible therapeutic options using precision medicine. Case presentation We used targeted gene sequencing to analyze the occurrence of 160 cancer-related genes in two patients with BG-ACC. KRAS and KDM6A mutations were detected in tumor samples collected from each patient. No KRAS mutations have been previously reported in salivary gland ACCs, indicating that the carcinogenesis of BG-ACC differs from that of the salivary gland ACCs. KDM6A mutations are often reported in salivary gland ACCs and facilitate novel gene-targeted therapy, including the use of BET and HDAC inhibitors. Conclusions A better understanding of the underlying genetic mechanisms will help to clarify the carcinogenesis of BG-ACC. In turn, this will enable treatment with novel targeting agents, as well as the initial exploration of gene-based precision oncological therapies, which aim to improve treatment outcomes for patients with this disease.

Bartholin gland abscesses are common problems in women and their management represents a mainstay of gynecology. Various treatment methods have been described. We present a technique performed under local anesthesia, without hospitalization or postoperative care. As part of a minimally invasive approach, this procedure promotes therapeutic de-escalation, has high patient acceptance, improves clinical outcomes and reduces costs. The procedure is highlighted through an instructive video article which standardizes the essential steps, to make the technique ergonomics and easy to perform (step-by-step explanation).

Mammary-like carcinoma of the vulva is incredibly rare with less than 30 cases published since 1935, and the similarities of such pathology between breast cancer metastases, squamous adenocarcinoma, Bartholin gland carcinomas, etc, make an accurate diagnosis challenging. A diagnosis can be made utilizing immunohistochemical staining and patient history to rule out more likely causes such as metastases to ensure a correct diagnosis.

Vulval cancer is rare. With Bartholin gland carcinomas representing

Adenoid cystic carcinoma (ACC) of the Bartholin gland is a rare gynaecological entity. Despite its slow growth and inconspicuous presentation, vulvar ACC has a propensity for perineural invasion and is therefore associated with high local recurrence rates. We report a case of vulvar ACC in a 61-year-old woman with a prolonged swelling of the Bartholin gland. This patient presented with pulmonary metastases at the moment of histological diagnosis. The vulvar and the pulmonary lesions showed identical histology. Despite a history of human papilloma virus (HPV)-related usual type vulvar intra-epithelial neoplasia and cervical squamous cell carcinoma, the vulvar ACC was negative for both p16 immunohistochemistry and HPV-DNA. We conclude that HPV is not involved in the pathogenesis of pure ACC of the Bartholin gland. Additionally, we advocate a low threshold for performing biopsies of vulvar swellings in women aged >40 years, to rule out malignancy and to prevent diagnostic delays.

Introduction Bartholin gland carcinoma is an extremely rare condition. Because of its, phase III trials have not been carried out, there exists no unanimous consensus on treatment and guidelines are missing. Methods All studies reporting cases of Bartholin cancer were collected and screened for the evaluations. Baseline characteristics of studies were extracted and were queried in a database. Results A total number of 133 manuscripts collected were available for the review process, representing a total number of 275 reported cases. The histological type of Bartholin gland cancer was specified in 90.4% cases: 30.7% cases were squamous cell carcinoma, 29.6% adenoid cystic carcinoma, 25% adenocarcinomas. At multivariate analysis adenocarcinoma histotype and positive lymph node were statistical correlated with worse prognosis. Conclusion Bartholin gland cancer remains a challenge for gynecologic oncologists. To better understand and treat this disease, centralization to referral centers and design of multi institutional trials is crucial.

To study the clinical and bacterial characteristic of Bartholin gland abscesses during pregnancy and the obstetric and neonatal outcomes.Retrospective cohort study of all patients with surgical treatment of Bartholin gland abscesses between 2004 and 2015 in our university center. Clinical and bacterial characteristics between pregnant and non-pregnant women were compared.During the period study, 156 patients were included (40 pregnant and 116 non pregnant). The incidence of Bartholin gland abscesses during pregnancy was 0.13%. Eight (20%) abscesses occurred in the first, 18 (45%) in the second, 11 (47.5%) in the third trimester and 3 (7.5%) in the post-partum course. No severe perineal and neonatal infections occurred during pregnancy. One late miscarriage and one preterm delivery were observed. We found more multiparity in the pregnant woman group than in non-pregnant women (62.5% versus 45%, p0.05). A history of Bartholin gland abscesses were also more frequent in pregnant women (55% versus 30.1%, p0.05). First line antibiotic therapy was more frequent in non-pregnant women (20% versus 45%, p0.05). The rate of positive culture did not differ between the two groups (70% versus 55.2%). Among negative pus cultures, no patient in the pregnant woman group had received a first line antibiotic therapy, in contrast with non-pregnant women (0% versus 25%, p0.05). E. coli was the most common pathogen in the two groups (48.9% of positive cultures and 28.2% of the overall population). The distribution of bacterial taxa was not different between the two groups.Bacterial characteristics did not differ from non-pregnant women. Pregnancy could increase the occurrence of Bartholin gland abscesses in patients with previous surgical treatment of abscesses. When appropriate management is applied, maternal and neonatal outcomes are favorable, and severe infections are not to be expected.

Objective To compare recurrence of a cyst or abscess of the Bartholin gland after surgical treatment using a Word catheter or marsupialisation. Design Multicentre, open-label, randomised controlled trial. Setting Eighteen hospitals in the Netherlands and one hospital in England. Population Women with a symptomatic cyst or abscess of the Bartholin gland. Methods Women were randomised to treatment with Word catheter or marsupialisation. Main outcome measures The primary outcome was recurrence of the cyst or abscess within 1 year of treatment. The secondary outcomes included pain during and after treatment (measured on a 10-point scale), use of analgesics, and time from diagnosis to treatment. Analysis was by intention-to-treat. To assess whether marsupialisation would reduce the recurrence rate by 5% (from 20 to 15%) we needed to include 160 women (alpha error 0.05, beta error 0.2). Results One hundred and sixty-one women were randomly allocated to treatment by Word catheter (n = 82) or marsupialisation (n = 79) between August 2010 and May 2014. Baseline characteristics were comparable. Recurrence occurred in 10 women (12%) allocated to Word catheter versus eight women (10%) allocated to marsupialisation: relative risk (RR) 1.1, 95% confidence interval (CI) 0.64–1.91; P = 0.70. Pain scores after treatment were also comparable. In the first 24 hours after treatment, 33% used analgesics in the Word catheter group versus 74% in the marsupialisation group (P

The emergency medicine provider sees a broad range of pathology involving the female genitourinary system on a daily basis. Must-not-miss diagnoses include pelvic inflammatory disease and ovarian torsion, because these diagnoses can have severe complications and affect future fertility. Although most patients with abnormal uterine bleeding are hemodynamically stable, it can present as a life-threatening emergency and providers should be adept managing severe hemorrhage. Bartholin gland cysts are common complaints that often require procedural intervention. This article discusses these diagnoses and appropriate evaluation and management in the emergency department.

Rationale: Post-hysterectomy collision tumors of the vulva has rarely been reported. Though long-term HPV infection may induce vulva tumor, but the relationship between HPV infection and collision vulva tumor is not clear. And there are no clear rules of the post-hysterectomy cancer surveillance for human papilloma virus (HPV) long-term infections. So here we first report a case of post-hysterectomy rare collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland and hope to bring new direction to our future research. Patient concerns: A 48-year-old woman with long-term HPV infection, 3 years after hysterectomy, gravida 3, para 2, was admitted to our hospital with complaints of a 4-month history of an itching vulva ulceration. An anabrosis was located on the surface of the solid mass of the bartholin gland at the posterior part of the right labium and the right inguinal lymph nodes were palpable. Result of the incisional biopsy of the ulcer area at local hospital was atypical squamous cells couldn’t exclude high-grade squamous intraepithelial lesion (ASC-H). Subsequently more authoritative pathological consultation results suggested squamous cell carcinoma of the vulva. Diagnoses: Post-hysterectomy collision vulva tumor with long-term HPV infection composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland. Interventions: The extensive excision of the vulva, bilateral inguinal lymph nodes dissection, and local skin flap transposition surgeon was done to this patient. The final certificate diagnosis was: vulvar tumor T1bM0N0 composed of squamous cell carcinoma of the labia major and adenosquamous carcinoma of bartholin gland; HPV infection; post hysterectomy, and bilateral salpingectomy. Outcomes: The patient recovered well after surgery, and consequently received 6 courses of TC (paclitaxel + carboplatin) chemotherapy, and 9 months and 13 days followed up. So far patient recorded as complete response (CR). Lessons: Collision vulva tumor occurred post-hysterectomy is extremely rare. It is most likely related to long-term HPV infection, which suggests us should to modify the manner of the post-hysterectomy cancer surveillance for HPV long-term infections. For patients with high-risk HPV infection, even if the cytology results are negative, we may should perform colposcopy and vulva biopsy more positively to prevent the disease from progressing into cancer. And the pathogenesis of relationship between HPV infection and collision vulva tumor is still need further investigation.

The data regarding microbiological and clinical characteristics of Bartholin gland abscesses during pregnancy is limited. Given the hormonal and physiological changes during pregnancy we aimed to examine whether a difference exists in the clinical and microbiological features of Bartholin's gland abscess during pregnancy and the puerperium as compared with nonpregnant patients. In addition, we aim to evaluate whether a Bartholin's gland abscess during pregnancy is associated with adverse pregnancy outcomes.A retrospective cohort study was conducted, including all women with Bartholin's gland abscess who were treated surgically between the years 2009-2016 in the Soroka University Medical Center. Various demographic, clinical and microbiological characteristics were retrieved and a comparison was made between patients with a Bartholin's gland abscess during pregnancy and the puerperium (study group) as compared with nonpregnant patients (controls). In addition, obstetrical characteristics of patients in the study group were retrieved.Of the 363 women who were treated surgically, 38 (10.5%) were in the study group. Women in the study group were significantly younger (26.8 versus 32.8In our cohort, no differences were found between the study groups in the clinical presentation and microbiological features. A significantly higher recurrence rate was noted in the study group. Among pregnant patients no adverse perinatal outcomes were noted.

Objectives: To assess the methods used to manage Bartholin gland abscesses and cysts in French university hospitals. Method: Data for this descriptive, cross-sectional study with self-reported data were collected between January and March 2018 by an online questionnaire. The 11 items of the questionnaire assessed the surgical techniques known and used, the type of hospitalization, and the non-surgical management to treat Bartholin gland abscesses and cysts. Results: Overall, 116 obstetrics-gynecology residents responded to the online questionnaire. The three best-known techniques were incision and drainage, marsupialization, and excision of the Bartholin gland. Only 3% of the physicians knew about other techniques. Most participants reported that their unit treated 2–6 Bartholin gland abscesses monthly and fewer than 2 cysts. The most frequent treatment for abscess was incision-drainage (87%), followed by marsupialization (13%). The most widely used treatment for the cysts was gland excision (68.5%) followed by marsupialization (22.5%). In both cases, management generally took place on an outpatient basis (92.9%). Conclusion: This study showed that 87% of the respondents used incision-drainage for Bartholin gland abscesses, although the recurrence and complication rates of this technique have never been evaluated.

This chapter describes the surgical procedure for incision and drainage of Bartholin gland duct cyst or abscess as performed by open approach. The text includes an introduction that outlines the indications, risks, alternatives, essential steps, needed equipment, and variations in technique for the procedure in question. This is followed by a template operative dictation, which provides the reader with an operative report, such as is found in a patient chart or electronic medical record. A description is provided of the following critical concepts for this procedure: bimanual examination, vertical incision, placement of Word catheter, or marsupialization.

Genital leiomyomas are rare tumors that can often be misdiagnosed as Bartholin cyst. We report a case of a 32-year-old patient who had a cystic nodulation in the left labium majus that was suggestive of Bartholin cyst. A resection surgery was performed, and the definitive histopathology diagnosis was vulvar leiomyoma. The macroscopic features of cystic lesions difficult the differential diagnosis between leiomyoma and Bartholin cyst; therefore, a histopathologic examination is often recommended.Os leiomiomas genitais são tumores raros, e frequentemente são diagnosticados como cisto de Bartholin. Relatamos o caso de uma paciente de 32 anos em que ocorreu nodulação cística no grande lábio esquerdo sugestiva de cisto de Bartholin. Uma cirurgia de ressecção foi realizada, e o diagnóstico histopatológico definitivo foi leiomioma vulvar. As características macroscópicas das lesões císticas dificultam o diagnóstico diferencial entre o leiomioma e o cisto de Bartholin, de modo que o exame histopatológico é frequentemente recomendado.

Around 2-7% of all vulvar cancers are represented by primary carcinomas of Bartholin gland. Here we are presenting such a rare case of carcinoma of Bartholin gland. 45/F P2L2 presented in our OPD with non-healing lesion in vulva for 2 months. She had history of Bartholin’s cyst excision (elsewhere), 2 months back (the exact time since when she is having the non-healing lesion in vulva). Diagnostic biopsy revealed it to be vulval squamous cell carcinoma. She was given two cycles of Neo adjuvant chemotherapy (Inj. Paclitaxel and Carboplatin). In view of better response to the treatment patient was planned for surgery. Patient underwent wide local excision with bilateral inguinofemoral lymphadenectomy. Although the majority of vulvar lesions are benign, especially in women younger than 50 years of age, any solid mass should be carefully evaluated for malignancy. Preferably biopsy of Bartholin gland should be considered if the patient is more than 40 years of age and should be mandatory in a menopausal woman.

Adenoid cystic carcinoma of the Bartholin gland is a rare vulval cancer. Available literature suggests an aggressive nature with protracted clinical symptoms and local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. This case demonstrates the role of neoadjuvant chemotherapy and interstitial brachytherapy with less radical surgery, in the treatment of adenoid cystic carcinoma of the Bartholin gland. A 63-year-old woman presented in the clinic four months after the removal of vulvar mass with histopathology report showing adenoid cystic carcinoma of the Bartholin gland with positive margins. Clinical examination and imaging showed local disease extension up to the levator ani and abutting anal margin. She was given four cycles of neoadjuvant chemotherapy followed by ipsilateral hemivulvectomy with inguino-femoral lymphadenectomy followed by 25 cycles of external beam radiation and three cycles of interstitial brachytherapy. The patient has been disease free for more than 30 months. The use of neoadjuvant chemotherapy in treatment of Bartholin carcinoma along with conser vative surgery and radiotherapy can be a good treatment strategy as it reduces the morbidity associated with radical surgery without recurrence to date.

To compare sexual function scores in patients who had marsupialization and gland excision procedures for the treatment of Bartholin gland abscesses.Patients who had bartholin abscess for the first time were randomized into marsupialization or gland excision methods. The primary outcome was to compare post surgical Female Sexual Function Index (FSFI) scores between the marsupialization group and the excision group. Secondary outcomes were to calculate the recurrence rates and other postoperative complications after the surgery.195 women were evaluated for the treatment of Bartholin abscess and 154 of them were included in our study. The final analysis was carried out on 134 participants. There was no statistically significant difference among the study groups in terms of age, BMI, gravidity, parity, site of the abscess, and diameter of the abscess. The mean diameter of the abscess was not significantly different among patients who had dyspareunia (4 ± 1.34 cm) and did not have dyspareunia (3.39 ± 0.99 cm). No recurrence was observed in the gland excision group while 5 patients had a recurrence of the abscess in the marsupialization group. Dyspareunia after the procedure was more common in patients who underwent marsupialization (2.9% vs 15.1%, p = 0.01). The FSFI scores were26.5 in both treatment groups. The total score was 24.76 ± 4.32 in the excision group and was 22.33 ± 5.15 in the marsupialization group.The excision of the gland for treating the Bartholin abscess resulted in less dyspareunia and recurrence when compared to the marsupialization procedure. Lower FSFI scores were reported in both groups, however, FSFI scores in the excision group were higher than in the marsupialization group. The excision of the Bartholin gland did not hamper sexual function.

Adenoid cystic carcinoma of the Bartholin Gland (BG-ACC) is a rare form of vulval cancer with only approximately 350 reported cases since 1864. A review of available literature and case reports suggests an aggressive nature with protracted clinical symptoms and a tendency for local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. Survival rates of 71% and 59% are reported at five and ten years. This case report endeavours to add to our body of knowledge regarding this rare disease and thus help broaden and improve our understanding of management and treatment success.

Primary cutaneous adenoid cystic carcinoma (PCACC) is an extremely rare tumor, which predominates in the face/head/neck, particularly in the salivary glands and is associated with characteristic histological features. In many tissue including the salivary glands, breast, esophagus, auditory canal, breast, uterus, cervix, bartholin gland, prostate, and skin this condition has been reported. PCACC affects men and women equally, and the etiology remains uncertain. Initial diagnosis of PCACC progresses slowly, expanding, firm, skin-colored nodule with locally invasive. To our knowledge, this is the first case of PCACC describing dermatoscopic features of this rare condition.

Glandular neoplasms of the vulvar are uncommon, and this chapter focuses on those entities that are particularly relevant with emphasis on confusing areas and potential pitfalls. Critical issues when managing Paget disease include ensuring the lesion arose in the vulva (versus anal region) and a clear understanding of the significance of invasion. Other adenocarcinomas, although rare, must be scrutinized to address potential origins, whether in the adnexal structures (Bartholin gland), mammary type tissue, cloacal remnants, or urethral mucosa. Adenoid basal cell carcinomas can be confused with adenoid cystic carcinomas, a potentially significant misdiagnosis. The specter of an exceeding rare monophasic (or nearly so) synovial sarcoma masquerading as a hidradenoma, primary adnexal or metastatic carcinoma carries with it treatment implications. Finally, neuroendocrine carcinomas (such as, Merkel cell carcinoma) round out this array of uncommon neoplasms, presenting its own challenges in diagnosis and management.

Bartholin gland carcinoma (BGC) is a rare malignancy (

Background Cystic lesions associated with the blockage of Bartholin gland ducts are frequently seen, but occurrence outside the normal vestibular localization is quite rare. Case A 16-year-old patient presented with a localized cystic lump approximately 4 cm in size on one of her labia minora. After an excision, she was diagnosed with an atypically localized Bartholin cyst. Summary and Conclusion It is very difficult to make an early diagnosis for an atypically localized Bartholin cystic lesion in adolescence; it can be diagnosed only after a pathological examination. In the differential diagnosis of a vulvar lump, an atypically localized Bartholin cyst should also be considered as a possibility.

BACKGROUND Vaginal cysts are a common finding. The differential diagnosis includes epidermal inclusion, Bartholin gland, Gartner duct, and Skene gland cysts and Mullerian anomalies. Rarely, leiomyomas, cancers, or ectopic ureters or megaureters are found. CASE A 31-year-old woman, gravida 3 para 3, presented with a 12-year history of intermittent abdominal pain and involuntary loss of urine. She was diagnosed with ectopic vaginal megaureter after evaluation and subsequently underwent a nephroureterectomy with a marsupialized distal ureter. She remains asymptomatic. CONCLUSION Consideration of a rare diagnosis such as an ectopic ureter is important when patients repeatedly present with involuntary urinary incontinence in conjunction with a vaginal cyst and an otherwise negative evaluation. Using magnetic resonance imaging can be useful to assess urinary tract involvement, particularly in patients with known urinary tract malformations.

Bartholin's gland cysts are one of the common vulval masses that may start as asymptomatic cysts but if left untreated, may become large and infected requiring medical attention. We are presenting two interesting and rare cases of giant Bartholin cyst and their treatment in this case report. Two female patients of perimenopausal age presented with giant vulval cysts to the outpatient department of Obstetrics and Gynaecology. They reached a size of 10 cm and 20 cm diameter respectively, presenting with some diagnostic and later reconstruction of the labia majus. MRI pelvis provided good information regarding the size, shape and extent of the cyst, which was very useful during surgery. Both these cases were successfully treated by excision of the cyst and histopathological examination after complete excision. One of the cases presented as dumb-bell shaped swelling with large cyst superiorly and smaller cyst extending into the buttock connected by narrow neck and showed cross fluctuation. This type of dumb-bell shaped presentation of Bartholin's cyst is rather unusual and has not been reported in the available literature.

Most lesions of the Bartholin gland are cysts or abscesses. Clinicians are taught that lesions of the Bartholin gland occurring in older women should raise the differential diagnosis of malignancy, although these are uncommon. A variety of more unusual and rare lesions of the Bartholin gland have been reported. This review focuses on these less common entities, which must be considered as well when encountering pathology of the Bartholin gland.

Highlights • Large vulvar mucinous cysts are exceedingly rare benign tumors. • If symptomatic, they can be carefully excised. • Knowledge of vulvar anatomy is essential to completely excise cyst walls., Background Vulvar mucinous cysts are rare, benign, noninvasive masses. They can be mistaken for cysts of Bartholin gland, Skene gland, vestibular, or canal of Nuck. Generally, they may be left untreated, but observed. However, if symptomatic, they may require surgical removal. Case We report a large vulvar mucinous cyst in a 29-year-old woman with no contributory medical history. Excision of the mass was performed because its size had begun to cause symptoms. The diagnosis of a mucinous cyst was based on radiological and clinicopathologic features. The patient developed a post-operative vulvar hematoma and was discharged 2 days after the surgery with a Foley catheter in place. Continued follow-up was maintained for the hematoma, which drained spontaneously and resolved without incident. There has been no recurrence of the cyst after completion of short-term surgical follow-up. Conclusion Vulvar mucinous cysts are rare masses. We present the diagnosis and treatment of a large vulvar mucinous cyst. The cyst was completely removed during surgery, but long-term surveillance for recurrence is currently being conducted.

Several benign, premalignant, and malignant lesions may arise on the vulva, and multiple types of procedures may be used to diagnose and treat these conditions. Punch and shave biopsies may be used to diagnose most vulvar conditions, but lesions suspected of being melanomas may best be diagnosed with narrow-margin excisional biopsies. Bartholin gland cysts and abscesses may be treated with several different treatment modalities, the most common of which are fistulization and marsupialization. Genital warts may be treated with several medical and surgical modalities to relieve symptoms.