Nodular hyperplasia, adenoma, and adenomyoma of Bartholin's gland

Bartholin Duct Cyst and Nodular Hyperplasia: A Clinicopathological Study of 32 Patients

Background: Inflammatory lesions and cysts are the most common Bartholin glands pathologic diagnoses. There have been very few reports of benign solid lesions of Bartholin glands such as nodular hyperplasia. Materials and methods: Thirty-two lesions diagnosed as Bartholin duct cyst in the gynecologic specialized institute were reviewed by two expert gynecological pathologists. Results: Using specific criteria, 7 qualified as nodular hyperplasia, 25 as Bartholin duct cyst. The average age of the patients with nodular hyperplasia was 31 years (range, 24 to 43). These lesions were solid, solid and cystic or purely cystic, had a mean maximal dimension of 3.3 cm, and were frequently thought to be Bartholin cysts on clinical examination. Four lesions were diagnosed as Bartholin duct cysts, while in the review they were considered as nodular hyperplasia. Conclusion: Nodular hyperplasia of Bartholin gland may be more common than is reported in the literature. This study showed that the diagnosis of nodular hyperplasia has been overlooked due to limited literature sources.

Mullerian Polyp of the Vagina: Report of Three Cases of a Previously Undescribed Lesion With Discussion of the Differential Diagnosis

Benign and malignant neoplasms of the vagina are rare. We report 3 primary vaginal polypoid lesions involving the upper or mid-vagina in patients aged 40, 60, and 67 years. The lesions bore a striking morphologic resemblance to benign endocervical or endometrial polyps and we suggest the designation Mullerian polyp of the vagina. As far as we are aware, similar cases have not been reported previously in the literature. Follow-up ranging from 6 to 21 months has been uneventful. In reporting these cases, we discuss the possible origin and differential diagnosis and review vaginal lesions with a benign glandular component.

Nonsquamous Lesions of the Vulvar Skin and Subcutaneous Tissue: A Review (Part 1)

OBJECTIVES

This article aimed to review "nonsquamous lesions of the vulvar skin and subcutaneous tissue" clinically and pathologically, based on the fifth edition of the World Health Organization tumor classification.

MATERIALS AND METHODS

A database search of PubMed and Google Scholar was performed between 1970 and 2021, using the search terms "vulva," "lower genital tract," and "nonsquamous lesions." The search was limited to "humans," "gynecopathology," and "dermatopathology." Full article texts were reviewed. Reference lists were screened for additional articles. We excluded articles written in the non-English language and abstracts.

RESULTS

A list of 600 articles was identified. Another screening identified 68 articles for clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue. In the first part of this review, we cover 5 major groups of nonsquamous lesions of the vulvar skin and subcutaneous tissue including (1) glandular tumors and cysts, (2) adenocarcinomas of other types, (3) germ cell tumors of the vulva, (4) neuroendocrine neoplasia, and (5) hematolymphoid hyperplasia and neoplasia. The rest of the major topics including mesenchymal tumors of the lower genital tract, melanocytic lesions, and metastasis will be discussed in the second part of this review.

CONCLUSIONS

Clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue as categorized by the updated World Health Organization classification are presented.

Pitfalls in Pathology-Nodular Hyperplasia of Bartholin's Gland

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.

Bartholin’s gland hyperplasia with dysplastic changes: a rare case report

The purpose of this paper is to report unusual, rarest and interesting case of a patient with nodular hyperplasia of Bartholin's gland with dysplastic changes. The case of a 30-year old female with right-sided Bartholin’s gland hyperplasia with dysplastic changes, which was confirmed histopathologically, is presented in this paper. The patient reported increased swelling of the right major labium when she became sexually aroused with intermittent dyspareunia during intercourse. Surgical excision of the swelling was done under general anaesthesia. Healing of the surgical scar was complete and she reported no any discomfort or dyspareunia during sexual intercourse. Bartholin’s gland swellings with firm consistency require complete excision due to possibility of being neoplastic rather than just inflammation, cyst or obstructed gland particularly in postmenopausal women. Diagnosis of nodular hyperplasia of Bartholin’s gland with areas of dysplastic changes in the present case is of great interest and requires further investigation.

A Report of Two Cases of "Giant Bartholin Gland Cysts" Successfully Treated by Excision with Review of Literature

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.

A Bartholin's gland with nodules and cysts bathed in mucus

The most common pathology of the Bartholin's gland is with its draining duct. Marsupialisation or fistulisation are the most common therapies. In some women, the clinical problem is with the Bartholin's gland itself, being hyperplasia with or without duct rupture in the subcutaneous tissue. Presenting symptoms and signs of nodular hyperplasia are pain and (nodular or diffuse) swelling especially during sexual arousal, or simply a symptomless mass. During surgery, the striking features are subcutaneous free-floating mucus and nodular enlargement ‘deep’ in the labium majus. The optimal surgical approach is an excision through an incision alongside the labiocrural fold.

We describe three cases to provide insight into the various clinical presentations and management problems. Nodular hyperplasia of Bartholin's gland is easily misdiagnosed because of its rare occurrence and diversity of signs and symptoms. An unusual presentation or clinical course of disease may indicate nodular hyperplasia.

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Nodular hyperplasia of Bartholin's gland has symptoms in common with ductal cysts

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Distinguishing signs are a deep solid swelling and a mucus-filled labium majus

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Optimal treatment is excising the gland through an incision of the labiocrural fold

Clinical Pathology of Bartholin's Glands: A Review of the Literature

The Bartholin's glands are located symmetrically at the posterior region of the vaginal opening and play an important role in the female reproductive system. These two pea-sized glands are involved in mucus secretion and vaginal lubrication. Cyst formation in the glands is common and results from mucus build-up in gland ducts. It is important to monitor such cysts because they may occur in the form of carcinomas. Larger cysts and abscesses are found in the lower vestibular region and typically present with erythema and edema. Biopsy is an effective method for distinguishing between Bartholin's gland cysts and differential diagnosis. While smaller cysts may be asymptomatic and may be left untreated, larger cysts require medical attention. Several treatment options are available, including marsupialization and CO2 laser. Healing and recovery depend on the severity of infection and course of treatment.

Bartholin's Gland Bilateral Nodular Hyperplasia: A Case Report Study

INTRODUCTION

Tumors which originate from the Bartholin's glands (BGs) are very rare. Many solid masses that arise from the BGs are carcinoma, though these benign solid lesions are rare.

CASE PRESENTATION

To the best of the reporter's knowledge, about 35 cases have been reported in the English literature so far, most of which accompanied with signs or symptoms of Bartholin's duct cyst. In this paper we report a 43-year-old woman with bilateral solid masses in the BGs, incidentally detected during anterior-posterior colpoperineoplasty. The masses were then excised.

DISCUSSION

The histopathological examination showed increased number of acini with preserved duct-acinar connection, consistent with nodular hyperplasia. The patient had used oral contraceptive pill for four years.

Bartholin's gland leiomyoma: a diagnostic and management dilemma

There are limited reports in the literature about Bartholin's gland leiomyoma, mainly due to its rare occurrence. This case report describes a 56-year-old woman presenting with a lump in her vulva. The initial suspicion was that of a Bartholin's gland carcinoma based on her clinical signs and symptoms. The mass was excised and the histopathology report described a leiomyoma. Differentiating between benign and malignant tumors by inspection alone can pose a diagnostic dilemma. There are no clear management guidelines but some authorities recommend that enlarged Bartholin's gland in postmenopausal women should be completely excised so as to exclude adenocarcinoma of the gland. However, other case reports and reviews have tried to justify an initial biopsy before considering complete excision to avoid unnecessary intervention in women whose biopsy confirms a benign lesion. In the case described, surgical excision was necessary and beneficial to the patient to provide symptom control.

Nodular Hyperplasia of the Bartholin Gland: A Clinicopathological Study of Two Cases, Including Detection of Clonality by HUMARA

The authors report two examples of nodular hyperplasia of the Bartholin gland. Each occurred in the vulva, close to the introitus of women aged 33 and 49 years, who presented with slightly painful lesions that were clinically thought to be cysts. Grossly, both masses exhibited a multilobular architecture, were elastic, were gray in color, and measured 4 cm and 3.2 cm in greatest dimension. On microscopic examination, the lesions looked similar and exhibited an increased number of secretory acini, with maintenance of the normal duct-acinar relationship--features compatible with nodular hyperplasia. Rare dilated ducts were observed, and intraluminal inspissated secretions were occasionally seen. In one case, there were a focal mild inflammatory infiltrate, squamous metaplasia of larger ducts, and rare ruptured ducts with extravasated stromal mucin. Clonality analysis performed in one case revealed a monoclonal pattern, suggesting that the lesion may be a neoplastic process rather than simple reactive hyperplasia.

Nodular hyperplasia of Bartholin’s gland

AIMS

There has been very little mention of benign solid lesions of the Bartholin's gland (BG) in pathology and gynaecology textbooks, and very few cases have been reported in the literature. Among these lesions, the distinction between nodular hyperplasia (NH) and adenoma has not been well defined. We report ten cases of NH of the BG, describe their clinicopathological, immunohistochemical and ultrastructural findings, and review the literature.

METHODS

We examined retrospectively all lesions involving BGs from our surgical pathology records from 1990 to 2004 with emphasis on NH. To separate NH from adenoma, we applied the criteria proposed by Koenig and Tavassoli. Special stains (PAS with and without prior digestion, Mayer's mucicarmine and Alcian blue with and without hyaluronidase) and immunohistochemistry (CAM5.2, AE1/AE3, HMWK, monoclonal CEA, EMA, ER, PR, ALA, SMA, Ki-67, p53 and polyclonal CEA) were performed on NHs. Two cases were examined ultrastructurally.

RESULTS

Using specific criteria, ten cases (age range 23-45 years; mean 36.1) of NH were identified, two of which were diagnosed previously as adenoma, but re-classified as NH. Clinically, these lesions were described either as Bartholin's duct cysts (BDCs) or vulvar lumps. Grossly, NHs were solid, tan and unencapsulated, measuring 12.5-45.0 mm in maximum dimension (mean 23.8). Histologically, the NHs were composed of a proliferation of mucus-secreting acini with preservation of the normal duct-to-acinar relationship. Chronic inflammation and squamous metaplasia were present. Eight lesions focally involved the surgical margins. Intracytoplasmic and intra-luminal secretions were positive for PAS with and without digestion, Alcian blue with and without hyaluronidase and mucicarmine. All lesions showed positive staining for CAM5.2, AE1/AE3, HMWK, EMA, and polyclonal CEA. There was negative staining for Ki-67, ER, PR, ALA, p53 and monoclonal CEA. Periacinar myoepithelial cells stained for SMA. Ultrastructurally, the findings included abundant intracytoplasmic secretory granules, granulofibrillar bodies, prominent Golgi and ribosomes. Myoepithelial cells were identified. There was no tumour recurrence or malignant transformation in eight patients with clinical follow-up.

CONCLUSION

NH of the BG is a rare lesion with benign behaviour. It is a distinct entity and can be separated histologically from an adenoma.

Polymorphous low-grade adenocarcinoma of the vulva and vagina: a tumor resembling adenoid cystic carcinoma

We report the first case of a polymorphous low-grade adenocarcinoma (PLGA) occurring in the vulva and vagina of a 32-year-old woman. This tumor consisted of cellular lobules with distinct cribriform, papillary, and cystic patterns. Owing to its location and its distinct cribriform pattern, this lesion was initially diagnosed as an unusual variant of adenoid cystic carcinoma (ACC). However, this diagnosis was revised to PLGA when it was recognized that the cribriform, papillary and cystic patterns and their concomitant occurrence in the same lesion are characteristic of PLGA. PLGA should be added to the differential diagnosis of vulvar and vaginal neoplasia.

Differential expression of mucin genes in mammary and extramammary Paget's disease

Paget's disease (PD) of the skin is characterized by intraepidermal adenocarcinoma cells, which contain clear cytoplasm and abundant mucin. Nearly all cases of mammary PD (MPD) are associated with underlying ductal carcinoma of the breast, whereas in the majority of cases of extramammary PD (EMPD) no underlying regional malignancy is identified. Mucins are high molecular weight glycoproteins produced by epithelial cells. Different mucin genes are expressed in various types of tissues such as mammary glands, intestinal mucosa, and adnexal structures of the skin. We studied the immunohistochemical expression of apomucin MUC1, MUC2, MUC5AC in MPD, and EMPD. MUC1 is commonly expressed in most cases of PD. MUC5AC is a unique mucin that is exhibited in the majority of cases of EMPD, but not in any MPD. Of the 13 patients with MPD who all had associated breast ductal carcinoma, both Paget cells and underlying ductal carcinoma exhibited the phenotype (MUC1+MUC2-MUC5AC-). This mucin phenotype is also expressed by Toker cells, which have been identified in the epidermis of five of 50 nipples in mastectomies without MPD. Of the three patients with perianal PD who all had associated rectal adenocarcinoma, Paget's cells expressed MUC2 constantly but expressed MUC1 and MUC5AC variably. Seven patients with intraepidermal vulvar PD and two patients with scrotal-penile PD had no identifiable underlying malignancy. Paget cells from all of these nine cases of EMPD expressed a uniform phenotype of mucin (MUC1+MUC2-MUC5AC+). One case of vulvar PD associated with underlying apocrine carcinoma had a phenotype (MUC1+MUC2-MUC5AC-) identical to that of normal apocrine glands. The skin appendage and Bartholin's glands from 20 normal-appearing vulvar skin samples and anal glands from 10 hemorrhoidectomies were also studied. Only Bartholin's gland expressed a mucin phenotype identical to that of intraepidermal EMPD. The results of the present study indicate that 1) MPD may arise from either mammary glands or epidermal Toker cells, 2) intraepidermal EMPD in the anogenital areas may arise from ectopic MUC5AC+ cells originating from Bartholin's or some other unidentified glands, and 3) unique expression of MUC2 in perianal PD indicates its origin from colorectal mucosa. We conclude that the study of mucin gene expression is useful in identifying the histogenesis of PD.

Concomitant adenoma and hybrid carcinoma of salivary gland type arising in Bartholin's gland

We report a unique case of a salivary gland type of "hybrid carcinoma" arising within a Bartholin's gland adenoma. The tumor was characterized by large areas of an epithelial-myoepithelial carcinoma similar to that of the salivary gland with a peripheral infiltrative pattern of an adenoid cystic carcinoma (ACC).

Nodular hyperplasia of the bartholin gland increasing in size during sexual intercourse

OBJECTIVE

A case of Bartholin gland nodular hyperplasia with review of the literature and diagnostic criteria is reported.

MATERIAL AND METHODS

In a 31-year-old woman, a nodular mass was found arising in the left labium minus. The mass size increased during sexual intercourse.

RESULTS

The mass was well-circumscribed but not encapsulated and showed a proliferation of acini lined by mucussecreting columnar epithelium. The lesion retained the lobular pattern and the relationship between acini and ducts as seen in the normal Bartholin gland.

CONCLUSION

Nodular hyperplasia of the Bartholin gland should be differentiated from adenoma, in which architecture is disrupted. Variation in size during sexual intercourse probably is mediated by vascular engorgement. Surgical excision is curative.