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

Salivary gland hybrid tumour revisited: could they represent high-grade transformation in a low-grade neoplasm?

Salivary gland hybrid tumour, first described in 1996, is a very rare neoplasm for which exact morphological criteria have not been universally agreed upon. In contrast, the concept of high-grade transformation (HGT) in salivary neoplasms has been widely accepted during the last decade, and the number of reported cases is rapidly increasing. A review of the literature revealed 38 cases of hybrid tumour reported in 22 publications. During approximately the same time period, well over 100 cases of HGT in salivary neoplasms have been reported. There are important histological similarities between hybrid tumours and salivary tumours with HGT. In the latter, containing one tumour component of low-grade malignancy and the other of high grade, the two tumour components are not entirely separated and appear to originate in the same area. Virtually, all cases reported as hybrid tumour had no clear lines of demarcation between the two tumour types. We are inclined to suggest that most of the 38 cases of hybrid tumours described in the literature would today better be called tumour with HGT rather than hybrid tumour. The relative proportion of the two components may vary, and the high-grade component is sometimes very small, which emphasises the importance of very generous sampling of the surgical specimen. The molecular genetic mechanisms responsible for HGT, including what used to be called hybrid tumour, remain largely unknown. Abnormalities of a few genes (including p53, C-MYC, cyclin D1, HER-2/neu) have been documented. As insufficient data exist on gene abnormalities in these lesions, conclusions as to whether or not they have a common origin and which mechanisms are involved in transformation cannot be drawn. Due to the small number of cases reported, many of which lack follow-up details; indicators of prognosis of hybrid tumours are not available, but their behaviour seems to be similar to that of tumours with HGT, i.e. an accelerated aggressive course. HGT of salivary gland neoplasms greatly influences macroscopic and microscopic evaluation of the specimen but also, given the high incidence of metastases and morbidity, carries significant treatment implications.

Myoepithelial carcinoma of the vulva mimicking bartholin gland abscess in a pregnant woman: case report and review of literature

Myoepithelial tumors of the vulva are extremely rare, with only 8 cases reported in the literature to date. We report the first case of a high-grade myoepithelial vulvar carcinoma diagnosed in a 35-year-old woman during the 27th week of her pregnancy. The patient initially underwent a wide local excision of the lesion but noted rapid regrowth of the vulvar mass during the next 2 months before her delivery. Shortly thereafter, she underwent a classic radical Taussig-Basset total radical vulvectomy, bilateral superficial and deep inguinal groin node dissection, partial vaginectomy, and reconstruction of the vulva. However, the patient rapidly developed both locoregional and distant mestatatic disease, despite aggressive chemoradiotherapy, and she eventually succumbed to disseminated disease almost 20 months after her initial diagnosis.

Adenoid cystic carcinoma of Bartholin's Gland. Case report with review of the literature

Adenoid cystic carcinoma of Bartholin's gland is characterized by slow growth, local invasion, and sometimes distant metastasis. There is no consensus regarding the optimal treatment. We report herein a rare case of stage II adenoid cystic carcinoma of Bartholin's gland that was successfully treated by wide local excision of the tumor and ipsilateral inguinal and pelvic lymphadenectomy. A 54-year-old Japanese woman was admitted complaining of painless, gradually increasing vulvar mass existing from ten years before. Local examination revealed a 3 x 2-cm hard mass in the left labium major. Pathological examination of subsequent excisional biopsy revealed adenoid cystic carcinoma originating in the Bartholin's gland. A wide local resection of the tumor with inguinal and pelvic lymphadenectomy was performed. The tumor was completely excised with free margins. There was no metastasis in the resected lymph nodes. The patient was diagnosed as having stage II vulvar cancer according to the International Federation of Gynecologists and Obstetricians classification (1988). The patient is now healthy without evidence of recurrence at 5 years after surgery. Adenoid cystic carcinoma of Bartholin's cyst at early stage can be treated by wide local excision as a primary surgery.

Myoepithelioma of the vulva

The histologic diagnosis of myoepithelioma is often problematic. We here describe a case of myoepithelioma, composed exclusively of neoplastic myoepithelial cells, in the vulva of a 52-year-old female. The vulva is a very rare site for this neoplasm. A subcutaneous tumor measuring 3.0 x 2.5 x 2.0 cm displayed a multinodular growth pattern. Histologically, it was characterized by epithelioid, trabecular, cord, solid, or reticular arrangements of tumor cells and markedly hyalinized stroma. The tumor cells were large and polygonal with eccentrically located round to oval nuclei with prominent nucleoli and eosinophilic cytoplasm. Some cells had clear cytoplasm. Moderate cellular atypia was seen and there were 4 mitotic figures per 10 high-power fields. No ductal architecture was found and there were no areas of chondroid or osseous differentiation. There was no destructive invasive growth. Immunohistochemically the tumor was positive for vimentin, epithelial membrane antigen, wide keratin, alpha-smooth muscle actin, S-100 protein, and glial fibrillary acidic protein. The patient was well and free of disease at 6 months. This neoplasm should be distinguished from other epithelial and mesenchymal neoplasms as it shows a different clinical behavior.

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.

Salivary gland-type basal cell adenocarcinoma of presumed bartholin's gland origin: a case report

Salivary gland-type carcinomas arising in Bartholin's gland are rare neoplasms. We report the case of a 75-year-old female who presented with a vulvar tumor with morphological and immunophenotypical features identical to those of salivary gland basal cell adenocarcinomas. We believe that the tumor was most likely of Bartholin's gland origin, although no Bartholin's gland tissue was found adjacent to the neoplasm. This type of malignancy with myoepithelial differentiation has not been previously reported to arise in the Bartholin's gland.