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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.

Introduction In the present study, we report a case of primary adenoid cystic carcinoma (ACC) of the Bartholin gland with high-grade transformation (HGT). Adenoid cystic carcinoma of the Bartholin gland is a rare tumor and HGT has only been reported in head and neck tumors. Case Report A 77-year-old woman with a non-ulcerated vulvar lesion on the topography of the right Bartholin gland. The patient was submitted to tumor resection followed by V–Y island flap and adjuvant radiotherapy. The histopathological examination revealed primary ACC of the Bartholin gland, with areas of HGT and extensive perineural invasion. The immunohistochemical study with p53 showed a diffuse and strong positive reaction in areas with HGT. After 24 months of follow-up, the patient presented distant metastases and died, despite having undergone to chemotherapy. Conclusion As far as we know, this case is the first description in the literature of HGT in ACC of the Bartholin gland, and HGT appears to be associated with tumor aggressiveness. Resumo Introdução Este estudo relata o caso de um carcinoma adenoide cístico (CAC) de glândula de Bartholin com transformação de alto grau. O CAC de glândula de Bartholin é um tumor raro, e sua transformação de alto grau é relatada somente em tumores de cabeça e pescoço. Relato de caso Paciente de 77 anos de idade, do sexo feminino, com lesão vulvar não ulcerada na topografia da glândula de Bartholin direita. A paciente foi submetida a ressecção do tumor e realização de retalho em V-Y, seguidas de radioterapia adjuvante. O exame histopatológico revelou CAC primário de glândula de Bartholin, com áreas de transformação de alto grau e invasão perineural. O estudo imunohistoquímico com p53 mostrou reação positiva difusa e intensa em áreas com transformação de alto grau. Após 24 meses de seguimento, a paciente apresentou metástases à distância e faleceu, apesar de ter sido submetida a quimioterapia. Conclusão Pelo que sabemos, este caso é a primeira descrição na literatura de transformação de alto grau em CAC de glândula de Bartholin, e a transformação de alto grau parece estar associada à agressividade do tumor.

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.