MR findings of a giant Bartholin's duct cyst

Huge Bartholin’s cyst managed by primary marsupialization: A case report

BACKGROUND

We report on the case of a 21-year-old female who could not walk due to a huge Bartholin's cyst occupying the right vulvar region. The patient was treated by marsupialization of the Bartholin’s cyst and postoperative antibiotic therapy.

CASE SUMMARY

A 21-year-old female without a medical history of sexually transmitted diseases presented to our outpatient clinic with complaints of a painful vulvar lump and a green-yellowish discharge for 4 d. A large Bartholin’s cyst, 10 cm in diameter, was suspected over the right side of the vulva. She was advised to be admitted to the ward for intravenous antibiotic treatment and to perform marsupialization several days later. However, the patient requested immediate surgery because of time limitations. The patient underwent marsupialization under local anesthesia. The procedure was well-tolerated. After making the incision, a significant amount of malodorous pus (approximately 30 mL) was removed from the abscess. The patient was followed up for 1 wk postoperatively. The Bartholin’s cyst regressed, and the surgical wound healed well.

CONCLUSION

Our case shows that an initial marsupialization followed by oral antibiotic therapy can be an appropriate treatment option for a large Bartholin’s cyst. However, depending on the patient’s condition, a suitable treatment, either cystectomy or marsupialization, can be considered.

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.

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.

Incidental bartholin gland cysts identified on pelvic magnetic resonance imaging

OBJECTIVE

To estimate the prevalence of Bartholin gland cysts in asymptomatic women serving as control participants who underwent pelvic magnetic resonance imaging (MRI) as part of research studies. The secondary aim was to investigate potential demographic characteristics associated with Bartholin gland cysts.

METHODS

Pelvic MRIs from 430 control participants enrolled in five research projects were evaluated. All images were evaluated by at least two authors. The presence, laterality, and size of Bartholin gland cysts were recorded. Demographic information for each participant was obtained at the time of enrollment in the respective parent study.

RESULTS

Approximately 3% of the participants had visible Bartholin gland cysts on MRI scans. Fifty percent of the cysts were identified on the right side, 42.9% were seen on the left side, and 7.1% were bilateral. The cysts were, on average, 1.3×1.2×1.3 cm with dimensions ranging from 0.5 to 2.7 cm. There were no demographic differences between women with and without visible Bartholin gland cysts.

CONCLUSION

Bartholin gland cysts occur in 3% of adult women. The cysts affect women of broad ranges of age and parity. Women with visible Bartholin gland cysts are demographically similar to women without cysts on pelvic imaging.

LEVEL OF EVIDENCE

II.