Case series on the management and outcomes of Bartholin gland carcinoma.

OBJECTIVE: To evaluate the management and outcomes of Bartholin gland cancer at a single tertiary institution. STUDY DESIGN: A single institution retrospective review of 9 cases of BGC between 2004 and 2022 was conducted. Demographics, pathological characteristics, treatment, follow up and oncologic outcomes were extracted from clinical records. Data are summarised using descriptive statistics and survival probabilities are presented with Kaplan Meier graphs. RESULTS: Ten cases of BGC were identified at our institution over a period of 18 years. Nine out of ten clinical records were available for analysis. Eight patients presented with vulval swelling and four were treated initially for Bartholin cyst or abscess. One patient had a histological diagnosis of adenoid cystic carcinoma while the remaining were squamous cell carcinomas. With the exception of stage I disease chemoradiation was the primary mode of treatment. Adverse events included skin desquamation (4/9), venous thrombo-embolism (2/9), gastro-intestinal (1/9) and neurotoxicity (1/9). Median follow up was 60 months with a 5-year recurrence free and overall survival at 76 % and 64 % respectively. CONCLUSION: BGC may present after a long duration of symptoms and at advanced stages. Primary chemoradiation appears to be a feasible treatment option in advanced disease with the benefit of decreased morbidity.

Bilateral bartholin's gland abscesses in a 4-year-old girl with vitamin a deficiency: a case report.

BACKGROUND: A Bartholin's gland abscess is one of the most common infections in women of reproductive age. Although Bartholin's gland abscesses have been reported in prepubertal children, they are rarer in prepubertal children than in adults. Herein, we report a case of bilateral Bartholin's gland abscesses in a 4-year-old girl with vitamin A deficiency. CASE PRESENTATION: A 4-year-old girl diagnosed with autism spectrum disorder was admitted to the hospital for close examination and treatment because of persistent fever and malaise. The child was a marked fussy eater and was diagnosed with corneal ulceration and night blindness secondary to vitamin A deficiency. Both of the patient's labia were swollen, and a diagnosis of a bilateral Bartholin's gland abscess was made using computed tomography. Incisional drainage was performed under general anesthesia. The patient's postoperative course was uneventful, and she was discharged from the hospital on day 8 after the surgery. During hospitalization, attempts were made to correct the vitamin deficiency by adding nutritional supplements to the diet. Three months after the surgery, no recurrence of abscesses was noted. CONCLUSIONS: Decreased immunocompetence and mucosal barrier function due to vitamin A deficiency is thought to be the underlying cause of Bartholin's gland abscesses. Although prepubertal Bartholin's gland abscesses have been reported, they are rare. To the best of our knowledge, no reports of bilateral Bartholin's gland abscesses potentially caused by vitamin A deficiency have been reported. When prepubertal girls present with Bartholin's gland abscesses, the presence of immunodeficiency due to vitamin or trace element deficiency should also be considered.

Adenoid Cystic Carcinoma of the Vulva: A Case Report.

Adenoid cystic carcinoma (ACC) of the vulva represents a highly uncommon type of female malignancy. Due to the absence of specific treatment guidelines, such cases are typically managed by the treatment protocols for vulvar cancer. Here, we report the case of a 52-year-old woman who presented with a painful right vulvar mass, leading to a diagnosis of ACC of the vulva after biopsy and immunohistochemical analysis. She underwent vulvectomy, bilateral inguinal lymphadenectomy, and targeted radiotherapy, and no evidence of recurrence has been found for three years, with ongoing monitoring for post-radiation effects. This case adds valuable insights into the management of ACC of the vulva and underscores the need for further research and guideline development to optimize care for future patients.

Comparison of Word Catheter and Marsupialization in the Management of Bartholin's Glands: A Systematic Review and Meta-Analysis.

OBJECTIVE: There is no consensus on the best option for the management of Bartholin's gland abscesses. This systematic review and meta-analysis aimed to compare the Word catheter placement and marsupialization methods in the management of women with a cyst or abscess of the Bartholin's glands. DATA SOURCES: The PubMed, Scopus, Embase, Web of Science, and Cochrane Library databases, as well as Google Scholar, were searched to retrieve articles published between January 1990 and July 2023, comparing the Word catheter treatment with marsupialization for women with a cyst or abscess of the Bartholin's glands. STUDY SELECTION: Both observational studies and randomized controlled trials (RCTs) were included in this meta-analysis. DATA EXTRACTION AND SYNTHESIS: After the review, out of 9 relevant articles, only 4 (2 observational studies and 2 RCTs) were included in this meta-analysis, providing the data of 735 patients (396 in the Word catheter group vs. 339 in the marsupialization group). The data was extracted from the selected articles, using a data extraction form. Comparison of the Word catheter and marsupialization methods suggested that the risk of recurrence was approximately 7.6% in the Word catheter group and 9.4% in the marsupialization group. The findings indicated no significant difference in the recurrence of cysts or abscesses when comparing the Word catheter treatment with marsupialization (odds ratio = 0.99, 95% confidence interval: 0.29-3.43, P = 0.990, I2 = 77%). CONCLUSION: This meta-analysis found no significant difference in the rate of recurrence between the Word catheter and marsupialization methods. In general, marsupialization and Word catheter placement in the treatment of Bartholinitis seem to be equally effective.

Management of primary and recurrent Bartholin's gland carcinoma: A systematic review on behalf of MITO Rare Cancer Group.

Bartholin gland carcinoma is an extremely rare disease. Information regarding treatment is scarce and there is no strict consensus on best practice. All studies reporting cases of Bartholin's gland cancer were screened and evaluated for inclusion. Baseline characteristics of studies were extracted. A total number of 290 manuscripts collected were available for the review process. Studies included in a previous systematic review were not duplicated. In total, details of 367 patients were collected, as follows: histological features, clinical presentation, treatment, recurrent rate, treatment of recurrence and outcome. About 35% of Bartholin gland carcinoma were squamous cell carcinoma. Almost 50% of patients presented with advanced stage. The therapeutic approach was mainly surgery, and in 61% of those women lymph node assessment was performed. Recurrence occurred in 21% of cases. Bartholin gland cancer remains a challenge for gynecologic oncologists. Guidelines, centralization to referral centers and standardized therapy are needed.

A Metastasis of Ovarian Cancer in the Bartholin Gland: A Case Report with Systematic Literature Review.

The metastasis of a gynecological malignancy to the Bartholin gland is rare. We report the case of a 62-year-old patient who had undergone extensive treatment of metastatic ovarian cancer that involved the liver, spleen, and peritoneum. She presented with painful swelling of the left vulva. Clinical and sonographic examinations showed a solid tumor in loco typico of the Bartholin gland. Surgical excision was performed. The patient died 3 months after the diagnosis of this metastasis. We performed a systematic search of PubMed, which yielded 453 entries. We selected those with at least an abstract available in English that described metastatic lesions on the Bartholin gland (n = 5). The review showed that a variety of primary cancers (colorectal, medullary thyroid, breast cancer, and endometrial cancers) metastasize to this location. Some patients showed signs of visceral metastasis. Bartholin gland metastases appeared as initial and metachronous manifestations. Most patients were symptomatic, with painful swelling or abscess. Genetic alterations were mentioned in some cases. The main pathways of metastasis discussed were lymphatic, but the mechanism of such metastasis remains unclear. Surgical resection was the preferred treatment option. The literature review indicated that Bartholin gland metastasis of ovarian cancer is rare and associated with poor prognosis. Oncological reasons for vulvar pathologies should be taken into consideration in patients with metastases.

Bartholin Gland Cyst Mimicking Rectocele: Common Pathology at an Uncommon Location.

Vaginal cysts are often encountered in gynaecological outpatient settings. These are usually asymptomatic in their initial course but become symptomatic when their size increases or they get infected. While evaluating such cases, clinical examination plays a vital role in ruling out their differential diagnoses. Imaging studies can complement clinical findings. However, in some instances, the nature of vaginal cysts may not be determined preoperatively until histopathology examination reveals it. We report here a rare case of a posterior vaginal wall cyst that presented as a mass protruding through the vagina. The clinical dilemma was the characterization of the cyst, owing to its huge size and rare location. The cyst was managed surgically by excision, and to our surprise, histopathological examination revealed it as a Bartholin gland cyst in the posterior vaginal wall, rare in its location.

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.

Bartholin's gland cyst caused by Sneathia amnii: a case report.

BACKGROUND: Sneathia amnii is a conditional pathogen of the female genital tract that is involved in bacterial vaginosis and poor reproductive and perinatal outcomes. Few studies have reported subcutaneous cysts following invasive infection caused by S amnii. CASE PRESENTATION: Here we report the case of a 27-year-old woman who presented with Bartholin's gland cyst due to S amnii infection, and was successfully treated with surgical neostomy and antibiotic agents. The isolate was gram-negative, bacillary, anaerobic, and was identified by polymerase chain reaction (PCR) amplification of the 16 S rRNA. CONCLUSIONS: S amni is an important but underappreciated pathogen that needs further investigation. This report describes the microbial and pathogenic characteristics of S amnii and is expected to provide a valuable reference in obstetric and gynecologic clinical practice.

Synchronous ovarian and Bartholin gland carcinoma: Case report and review of literature.

To our knowledge, this is the first reported case of synchronous ovarian and vulva (Bartholin gland) cancer. A postmenopausal woman presented with a complex multiloculated left adnexal mass and 2-cm right Bartholin gland mass. CA 125 was 59 IU/mL. Computed tomography of chest, abdomen, and pelvis showed a very large (32 × 13.5 × 22.5 cm) complex mass arising from the pelvis and extending to the level of the T12/L1 disk space. A right Bartholin mass with suspicious right inguinal nodes was seen. Midline laparotomy, total abdominal hysterectomy, bilateral salpingo-oophrectomy, infracolic omentectomy, pelvic peritoneal biopsies, and peritoneal washings were carried out. Wide local excision of the right Bartholin gland mass was carried out in the same setting. Histopathology came back as Stage 2B left ovarian clear-cell carcinoma and synchronous right Bartholin gland adenoid cystic carcinoma with lymphovascular invasion, incompletely excised, staged at least FIGO Stage 1B. Following local multidisciplinary team discussion and positron emission tomography scan review, the local committee agreed to start three cycles of adjuvant chemotherapy then proceed with Bartholin gland scar re-excision and bilateral groin lymph node dissection. After the three cycles, the groin lymph nodes came back as metastatic adenocarcinoma with overall morphologic and immunohistochemical features consistent with metastatic ovarian clear-cell carcinoma. Postoperative adjuvant chemotherapy was given. Initial follow-up period over 9 months was uneventful.

Adenoid Cystic Carcinoma (ACC) of the Bartholin's gland misdiagnosed for three times: a case report.

BACKGROUND: Adenoid cystic carcinoma (ACC) in Bartholin's gland is an uncommon malignant tumor. These tumors have a vague clinical feature, so they are diagnosed late and discovered at a high-level stage. Our case presented Three Recurrences and Three times Misdiagnosis of Adenoid Cystic Carcinoma (ACC). CASE PRESENTATION: We report a case of adenoid cystic carcinoma arising in Bartholin's gland of a 64-year-old female patient that appeared after three previous vulvar tumors were excised. The patient underwent bilateral radiotherapy which was performed on the perineum. CONCLUSION: ACC of the vulvar sweat glands is prone to misdiagnosis and delay in both diagnosis and treatment. As seen in our case, it was misdiagnosed three times as Chondroid Syringoma. Further studies need to be conducted to better understand the tumor prognosis, and its optimal treatment options.

Challenges in management of Bartholin gland leiomyoma: A case report.

Leiomyomas are uncommon vulvar neoplasms often misdiagnosed as other Bartholin gland pathology. This case report describes a case of accelerating growth of a vulvar mass, initially diagnosed as Bartholin cyst. Surgical excision led to a histopathologic diagnosis of vulvar leiomyoma. The postoperative recovery was complicated by secondary hematoma and dehiscence of the surgical site. There was no recurrence at 2 years follow-up.

Adenoid cystic carcinoma of Bartholin's gland, a case report with genomic data and literature review.

Adenoid cystic carcinoma of the Bartholin's gland (ACCBG) is a rare, slowly but aggressive malignancy. We reported the case of a 31-year-old woman who was treated by local excision and then hemi-vulvectomy, with positive margins and perineural invasion. Radiation therapy (RT) was then performed delivering 45Gy in 25 fractions in bilateral inguinal lymph nodes and 64.8Gy in 36 fractions on the vulvar area. After 30 months, there was no local relapse (LR) but the patient presented a histologically documented lung recurrence. Genomic profiling of the tumor showed a MYB-NFIB fusion transcript and a somatic mutation of PLCG1. A treatment by Lenvatinib was started. We conducted a literature review of 100 published cases. Patients were mainly treated by radical vulvectomy (30%), hemi-vulvectomy (17%), wide or local excision (21% and 24%, respectively) or other. Forty-four percent of patients received postoperative RT, more frequently in case of positive margin (71.9% versus 29.5%). RT may reduce the risk of LR regardless of margin status, with 15.4% vs. 41.9% of LR with or without RT, respectively, in patients with negative margins, and 13% vs. 33.3% of LR with or without RT, respectively, in patients with positive margins. The risk of relapse of any type was 40.9% in patients who received adjuvant RT vs. 48.2% in patients who did not. Median time to relapse was 24 months (range 6-156 months). The most frequent metastatic sites were lung (76.7%) and bone (26.7%). Optimal treatment for ACCBG is still not clearly defined but pooling the data from published case report help us better understand this rare disease and help in the therapeutic decision.

Bartholin's gland carcinoma-the diagnostic and management challenges of a rare malignancy-a case report and review of current literature.

Background: Bartholin's gland carcinoma (BGC) accounts for approximately 5% of all vulval malignancies-making it an extremely rare malignancy of the female genital tract. It commonly manifests as a painless unilateral mass, near the introitus. BGC more commonly occurs in post-menopausal women. Unfortunately, over half of cases are associated with a missed or delayed diagnosis as it is often mistaken for a Bartholin's gland cyst or abscess. These tumours have a predilection for local and perineural invasion. Magnetic resonance imaging (MRI) is the imaging modality of choice for suspected Bartholin's tumour. Although no current guidance dedicated to the management of BGC exists, the majority of cases are treated by primary excision and bilateral groin node dissection (GND). Chemoradiotherapy has a role in both the adjuvant and palliative setting. BGC are typically associated with more advanced disease at presentation, higher rates of recurrence and poorer prognosis than other vulval cancer sub-types. Case Description: We share a case report of primary BGC-supported by high-quality radiological and surgical images; and further supplemented by a detailed review of current literature. Conclusions: We aim to generate improved clinician awareness of this rare pathology, highlighting the need for vigilance to avoid misdiagnosis and subsequent treatment delay; as well as contribute towards generating consensus on the approach to management of this gynaecological malignancy.

Encapsulated Hematoma of the Bartholin's Glandule.

Bartholin's glands are important organs of the female reproductive system. These glands have the function of producing an alkaline mucoid secretion, which helps in vaginal and vulvar lubrication. There are several types of lesions that can be identified in these anatomical structures, where in most cases presented for medical examination, cysts and abscesses predominate. This is the presentation of a clinical case of a 55-year-old patient, who is presented to the surgeon for her complaints. Once the woman is examined, diagnosed, and treated adequately, she is taken into consideration for presenting her case in this study, while maintaining confidentiality. The presented clinical case provides a clinical framework not easy to establish an accurate diagnosis of a Bartholin gland cyst. Careful physical examination by the surgeon and careful preparation with electrosurgery verified the cyst-hematoma left and just above the posterior fornix, where some material was taken from the cyst capsule and hematoma and sent for histological examination. The histological response concluded with cystic hematoma of the Bartholin gland. Cystic lesions of the vagina are relatively common and usually represent a benign condition. Ways of managing Bartholin gland cysts vary depending on the discomfort they bring to the patient as well as the size or even the anatomical extent of the cystic lesion. However, the physical examination, with a careful inspection by the surgeon, combined with the imaging examinations, requires a biopsy examination, which is the confirmation of the diagnosis.

Neoadjuvant chemotherapy followed by radical vulvectomy for adenoid cystic carcinoma of Bartholin's gland: a case report.

Background: Adenoid cystic carcinoma (ACC) of the Bartholin's gland is a rare cancer of the female genital tract for which there is no consensus on treatment. As there are no current reports on neoadjuvant chemotherapy followed by surgery for this disease, our case explores the effectiveness of neoadjuvant chemotherapy. Case Description: We report a case of ACC of Bartholin's gland. The patient is a 69-year-old woman with a left vulvar mass. Pelvic magnetic resonance imaging (MRI) showed a left perineal occupying lesion with indistinct boundaries to the surrounding tissues. The patient received two cycles of neoadjuvant chemotherapy with a regimen of paclitaxel combined with cisplatin and the mass was significantly reduced. Subsequently, she received a radical vulvectomy and left inguinal lymph node dissection. The operation was successful, and the patient was treated with simultaneous radiotherapy and chemotherapy after the surgery. The patient is currently 14 months postoperative and reports no significant pain with normal urination and defecation. The pelvic MRI was reviewed regularly, and there was no sign of recurrence. Conclusions: After neoadjuvant chemotherapy, the extent of the lesion was significantly reduced, which reduced the difficulty of surgery, thus reducing surgical complications and enabling complete resection of the tumor tissue. Based on the treatment of this patient, we speculate that preoperative neoadjuvant chemotherapy may be a better choice for patients with extensive and fixed lesions.

Analysis of clinical outcomes of patients with primary rare carcinoma of Bartholin gland: six case series report and review of the literature.

Background: Bartholin gland carcinoma (BGC) is an unusual malignancy representing less than 5% of all vulval carcinomas. Due to the limited published information on the diagnosis and treatment of BGC, this tumor is prone to misdiagnosis; most cases are found in an advanced stage once the diagnosis is delayed. Methods: This was a retrospective study of six patients with BGC in the West China Second University Hospital between January 2011 to August 2021. Results: In our study, BGC was 4.4% in all vulvar malignancies. The average age of six patients was 40.83 years old, with the tumor size ranging from 2 to 5 cm, and time of onset ranging from 2 to 3 years. Based on the retrospective clinical staging, there were three patients in stage I, one in stage II, and two in stage IVb. The human papillomavirus (HPV) 16 was detected in tissue samples of three patients. Two patients with excision of the vulvar mass and wide local excision (WLE) had local recurrence at 32 and 18 months, respectively. One patient died of distant metastasis of tumor, one died of non-tumor cause, and the others survived to this day. Conclusions: Six patients with BGC were reviewed in this study, and their characteristics of baseline information, clinicopathology, treatment approaches, and prognosis were described and analyzed, hoping to provide new insights for the diagnosis or treatment in this rare malignancy.

Acute Bartholin's gland abscess treatment by simple needle aspiration: A prospective study.

OBJECTIVE: This study aim was to examine the success rate of simple needle aspiration for acute Bartholin's gland abscess and compare it to incision and drainage treatment. STUDY DESIGN: This was a non-randomised prospective study conducted at the academic Hospital of La Conception, Marseille, France. We included 202 women who presented with acute Bartholin's gland abscess between June 2013 and October 2017. The study cohort was subdivided into two treatment groups, simple needle aspiration (134 women) or incision and drainage (42 women), according to the women's preference. Success was considered as the absence of surgical treatment within one year of the initial treatment. RESULTS: The success rate was 68/134 (51% (95% CI: 42-59%)) in the simple needle aspiration group and 25/42 (60%) in the incision drainage group (RR: 0.85, 95% CI: 0.63-1.15, P = 0.3). Among 122/134 (91%) women who completed the satisfaction survey, 99/122 (81%) were satisfied with the simple needle aspiration. CONCLUSIONS: Simple needle aspiration can be offered as first-line treatment for acute Bartholin's gland abscess. Simple needle aspiration can be performed as an outpatient procedure without general anesthesia avoiding surgical treatment in half of the cases one-year post- simple needle aspiration.

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.