High-Grade Transformation in Adenoid Cystic Carcinoma of the Bartholin Gland: Case Report / Transformação de alto grau em carcinoma adenoide cístico de glândula de Bartholin: relato de caso

Abstract 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.

Angiomixoma pélvico agresivo. Reporte de un caso / Aggressive pelvic angiomyxoma. A case report

El Angiomixoma Agresivo (AA) del suelo pélvico es una rara neoplasia mesenquimal de histología benigna, pero con un comportamiento característico localmente agresivo, que frecuentemente se presenta en mujeres en edad reproductiva. Suele presentar un crecimiento insidioso desde su origen en la musculatura perineal, lo que conlleva una clínica inespecífica, sutil y generalmente de larga evolución. El diagnóstico por la imagen, principalmente a expensas de la Tomografía Computarizada (TC) y la Resonancia Magnética (RM) con contraste, es de notable importancia, tanto por permitir detectar y caracterizar fiablemente una entidad poco frecuente, como por facilitar una planificación quirúrgica adecuada que permita obtener márgenes de resección libres de enfermedad, incluso en aquellos con infiltración de las estructuras vecinas. Presentamos el caso de una paciente adolescente con antecedente de tumoración en región vulvar derecha, en relación con extensión de un gran tumor retroperitoneal cuyo estudio histológico confirmó un Angiomixoma Agresivo.

Aggressive angiomyxoma of the pelvic floor is a rare mesenchymal neoplasm of benign histology, but with a characteristic locally aggressive behavior, which mostly occurs in women of reproductive age. It usually presents an insidious growth from its origin in the perineal musculature, which leads to a non-specific, subtle and generally long-lasting clinical course. Diagnostic imaging, mainly at the expense of CT and MRI with contrast, is of notable importance, both for allowing detection and reliable characterization of a rare entity, and for facilitating adequate surgical planning to obtain disease-free resection margins, even in those with infiltration of neighboring structures. We present the case of an adolescent patient with a history of tumor in the right vulvar region, which imaging studies confirmed to be the extension of a large retroperitoneal tumor whose pathological anatomy describes as an aggressive pelvic an angiomyxoma.

[Abscess of the bartholino gland]. / Absceso de la glándula de bartolino.

Introduction: Bartholin's glands, also known as major vestibular glands, are responsible for a large number of gynecological diseases of the vulva. Bartholin's gland cysts and abscesses can present with different symptoms and the required surgical management should be marsupialization and not incision and drainage. Although the incision and drainage procedure was shown to be relatively quick and easy to perform, and the cure rate is rapid among patients receiving this type of surgical technique, it has nevertheless been shown that the recurrence trend has increased. Objective: to carry out an updated bibliographic review on the subject and its best management. Data Source: A systematic bibliographic search of the PubMed, Hinari and academic google databases was carried out from 1985 to 2020. Conclusions: The best level of care for women with Bartholin's gland cysts or abscesses could never achieved without interprofessional collaboration.

Introducción: Las glándulas de Bartolino, también conocidas como glándulas vestibulares mayores, son responsables de un gran número enfermedades ginecológicas de la vulva. Los quistes y abscesos de la glándula de Bartolino pueden presentarse con síntomas diferentes y el manejo quirúrgico requerido debe ser marsupialización y no incisión y drenaje. Aunque se demostró que el procedimiento de incisión y drenaje es relativamente rápido y fácil de realizar y que la tasa de curación es rápida entre los pacientes que reciben este tipo de técnica quirúrgica, sin embargo se ha demostrado que la tendencia de recurrencias ha aumentado. Objetivo: realizar una revisión bibliográfica actualizada sobre el tema y su mejor manejo. Fuente de Datos: se realizó una búsqueda bibliográfica sistemática en la base de datos PubMed, Hinari y google académico desde el año 1985 al año 2020. Conclusiones: El mejor nivel de atención para las mujeres con quistes o abscesos de la glándula de Bartolino nunca podría lograrse sin la colaboración interprofesional.

Is electrosurgery fulguration a better procedure for Bartholins gland cyst?

SUMMARY OBJECTIVE To evaluate the effectiveness of electrosurgery fulguration as a treatment for Bartholin's gland cysts. DESIGN Retrospective study with a comparative control group performed on Hospital Brigadeiro and in the Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo from February 2005 to March 2009. Patients: Patients with Bartholin's gland cyst were divided into three treatment groups: group 1 electrosurgery (n=169 cases); group 2 - gland excision with the conventional technique using a cold scalpel (n = 51 cases); group 3 - marsupialization (n=11 cases). We reviewed the clinical and surgical history, physical examination, description of the surgical technique, postoperative results (success and complications), and follow-up data. RESULTS There is no difference between groups in relation to intraoperative bleeding, hematoma, and complete healing in a single treatment session. However, electrosurgery shows the lower percentage of recurrences 18 (10,7%) compared to the Marsupialization technique (group 3, p=.031). Recurrences occurred in 18 (10,7%), 3 (5,9%), and 4 (36,4%) cases. After retreatment by the same technique, there was a complete cure rate of 90% (152/169) for group 1, and 98% (50/51) for group 2. The cost of group 1 was lower than that of other groups. CONCLUSION The fulguration with electrosurgery of the capsule of Bartholin's cyst is an effective method of treatment, andthe cost of this technique is lower than the conventional technique and marsupialization.

RESUMO OBJETIVO Avaliar a eficácia da fulguração da eletrocirurgia como tratamento para os cistos da glândula de Bartholin. MÉTODOS Estudo retrospectivo, grupo controle comparativo realizado no Hospital Brigadeiro e disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de fevereiro de 2005 a março de 2009. Pacientes com cisto de glândula de Bartholin foram divididos em três grupos de tratamento: grupo 1 - eletrocirurgia (n = 169 casos); grupo 2 - excisão da glândula com técnica convencional utilizando bisturi frio (n = 51 casos); grupo 3 - marsupialização (n = 11 casos). Revisamos a história clínica e cirúrgica, o exame físico, a descrição da técnica cirúrgica, os resultados pós-operatórios (sucesso e complicações) e os dados de acompanhamento. RESULTADOS Não há diferença entre os grupos em relação ao sangramento intraoperatório, hematoma e cicatrização completa em uma única sessão de tratamento. No entanto, a eletrocirurgia mostrou o percentual mínimo de recidivas, 18 (10,7%), em relação à técnica de marsupialização (grupo 3, p = 0,031). Recorrências ocorreram em 18 (10,7%), três (5,9%) e quatro (36,4%) casos. Após o retratamento pela mesma técnica, houve taxa de cura completa: 90% (152/169) para o grupo 1 e 98% (50/51) para o grupo 2. O custo do grupo 1 foi menor do que os dos outros grupos. CONCLUSÃO A fulguração com eletrocirurgia da cápsula do cisto de Bartholin é um método efetivo de tratamento, mas o custo dessa técnica é menor do que a técnica de convenção e a marsupialização.

The adenoid cystic carcinoma of the Bartholin's gland: a literature review

The adenoid cystic carcinoma (ACC) of the Bartholin's gland (BG) is one of the most uncommon variant of vulvar malignancies representing only 10­15% of cases. The main differential diagnosis is the BG cyst. Risk factors to the development of ACCBG are still unclear. The symptoms are usually non-specific and may include local inflammation, pain, local itching, burning sensations, bleeding, pruritus and or dyspareunia. There is currently no consensus regarding the optimal surgical treatment and the question whether to do or not a systematic inguinal femoral lymph node dissection is still controversial. Guidelines for postoperative chemotherapy or chemoradiotherapy are not established, despite the relative frequency of microscopically positive surgical resection margin. Adjuvant radiation therapy seems to lower the incidence of local recurrence in patients with positive resection margins, based on retrospective studies and case reports. Chemotherapy as adjuvant treatment is still under evaluation

Differential Diagnosis between Bartholin Cyst and Vulvar Leiomyoma: Case Report / Diagnóstico diferencial entre cisto de Bartholin e leiomioma vulvar: relato de caso

Abstract Genital leiomyomas are rare tumors that can often be misdiagnosed as Bartholin cyst. We report a case of a 32-year-old patient who had a cystic nodulation in the left labium majus that was suggestive of Bartholin cyst. A resection surgery was performed, and the definitive histopathology diagnosis was vulvar leiomyoma. The macroscopic features of cystic lesions difficult the differential diagnosis between leiomyoma and Bartholin cyst; therefore, a histopathologic examination is often recommended.

Resumo Os leiomiomas genitais são tumores raros, e frequentemente são diagnosticados como cisto de Bartholin. Relatamos o caso de uma paciente de 32 anos em que ocorreu nodulação cística no grande lábio esquerdo sugestiva de cisto de Bartholin. Uma cirurgia de ressecção foi realizada, e o diagnóstico histopatológico definitivo foi leiomioma vulvar. As características macroscópicas das lesões císticas dificultam o diagnóstico diferencial entre o leiomioma e o cisto de Bartholin, demodo que o exame histopatológico é frequentemente recomendado.

Metastasis pulmonares tardías de carcinoma adenoideo quístico de la glandula de bartolino / Late lung metastases of cystic adenoid carcinoma of the bartolino gland

El carcinoma adenoideo quístico de la glándula de Bartolino (GB) es una entidad infrecuente, de crecimiento lento y comportamiento agresivo con alta recurrencia local y metástasis. Presentamos el caso de una paciente de 48 años, con antecedente de tratamiento quirúrgico de un absceso Bartolino derecho. La biopsia demostró un carcinoma adenoideo quístico (CAQ) de la GB, por lo que se realizó hemivulvectomía radical derecha y linfadenectomía inguinofemoral. El resultado de la biopsia mostró 4 ganglios positivos de 12 y margen lateral positivo a menos de 2 mm. Por lo que se realizó adyuvancia con radioterapia. La paciente no se presenta a su control y acude luego de tres años por dolor urente desde cadera izquierda hacia rodilla y cara lateral de la pierna y pie. Se realiza cintigrama óseo que muestra lesión osteoblástica sacroilíaca izquierda de 2 cm, por lo que se completó estudio de diseminación con tomografía computada de tórax, abdomen y pelvis con contraste que evidenció múltiples lesiones nodulares pulmonares bilaterales de distribución generalizada en parénquima central, periférico y subpleurales. Se deriva al Instituto Nacional del Tórax, completando estudio preoperatorio y se realizó una biopsia quirúrgica por video toracoscopía resecando un nódulo subpleural, el informe histológico señaló una metástasis de CAQ concordante con primario en GB. La paciente fue presentada en el comité oncológico y se indicó radioterapia paliativa a lesión sacroilíaca y control clínico ambulatorio. Ha evolucionado estable desde el punto de vista funcional pulmonar.

Adenoid cystic carcinoma of Bartholin glands (BG) is a rare, slow-growing but a highly aggressive tumor with remarkable capacity for local recurrence and distant metastasis. We present the case of a 48 year-old female patient with a history of surgical treatment for right Bartholin abscess. The biopsy showed a cystic adenoid carcinoma of the BG, which led to radical hemivulvectomy and inguinofemoral lymphadenectomy. The biopsy show inguinal lymph node metastasis on 4 of 12 lymph nodes and positive surgical resection margin. Adjuvant radiotherapy was applied. The patient doesnt present to her clinical follow up, and consult three years later with radiological evidence of sacroiliac metástasis on bone scintigraphy. Study was completed with thorax, abdomen and pelvis tomography scan, and showed multiple bilateral lung nodules. The patient was transfered to National Thoracic Institute, and preoperative study was performed. We decide to obtain histologycal confirmation by a video thoracoscopy, it was performed without incidents. Histology show metastasis of adenoid cystic carcinoma pattern, concordant with primary tumor. The patient was submitted to the oncology committee and palliative radiotherapy was indicated for sacroiliac lesion. The patient evolve stable and asintomatic at ambulatory clinical control.

Angiomixoma agresivo: reporte de un caso y experiencia global con 168 casos / Aggressive angiomyxoma: Case report and global experience of 168 cases

Resumen ANTECEDENTES: el angiomixoma vulvar agresivo es una neoplasia poco frecuente, de origen mesenquimatoso, que suele afectar la región pélvica y perineal, con alto grado de infiltración y recurrencia local. El tratamiento de elección es la extirpación quirúrgica. CASO CLÍNICO: mujer de 39 años de edad, que inició con una tumoración vulvar derecha de 6 cm, de consistencia blanda, móvil, no dolorosa, sin ulceraciones, clasificada como quiste de la glándula de Bartholin; se efectuó resección quirúrgica de la lesión sin inconvenientes ni complicaciones. En el servicio de Cirugía Oncológica del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, se solicitó una tomografía axial computada que evidenció una tumoración heterogénea, hipodensa, vascularizada, con componente quístico que desplazaba el conducto vaginal, útero y vejiga, con infiltración de tejidos blandos y piel, de 15 x 10 x 28 cm en el labio mayor derecho. Con la biopsia incisional se estableció el diagnóstico de angiomixoma agresivo profundo. En diciembre de 2016 se extirpó el tumor vulvoperineal. El reporte patológico fue de tumoración de 30 x 25 x 7 cm, con receptores positivos para estrógenos y progesterona, e intensidad +++ en más de 80%. La paciente recibió tratamiento coadyuvante con tamoxifeno; actualmente se encuentra asintomática y en vigilancia. CONCLUSIONES: la prescripción de agentes antiestrogénicos disminuye el tamaño tumoral. Este tratamiento supone abordajes quirúrgicos menos agresivos. Por la recurrencia del angiomixoma agresivo se sugiere la vigilancia a largo plazo e implementar un esquema de mantenimiento con fármacos antiestrogénicos.

Abstract BACKGROUND: Aggressive angiomyxoma of the vulva is a very rare mesenchymal neoplasm, which has a preference for the pelvic and perineal regions. It is defined to be aggressive because of its tendency to infiltrate and local recurrence. The treatment of choice is surgical excision. CLINICAL CASE: A 39-year-old female, who started with a 6 cm right vulvar tumor, soft, mobile, non-painful, without ulcerations, classified as a cyst of the Bartholin's gland; surgical resection of the lesion was performed without incidents or complications. In the Oncology Surgery service (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán), a computerized axial tomography was requested, wich evidenced a heterogeneous, hypodense, vascularized tumor with cystic component that displaced the vaginal canal, uterus and bladder, with infiltration in soft tissue and skin, of 15 x 10 x 28 cm on the right upper lip. The incisional biopsy established of deep aggressive angiomyxoma diagnosis. In December 2016 the vulvoperineal tumor was extirpated. The Department of Pathological Anatomy reported a tumor of 30 x 25 x 7 cm, with estrogen and progesterone positive receptors, and intensity +++ in more than 80%. The patient received adjuvant treatment with tamoxifen. Currently the patient is asymptomatic and under follow-up. CONCLUSIONS: The use of antiestrogenic agents has been shown to decrease tumor size. This protocol requires less aggressive surgical approaches. Given the tendency of these tumors to recur, it is necessary to provide long-term follow-up considering the treatment with antiestrogens as a maintenance therapy.

Treatment of Bartholin gland cyst with CO2laser / Tratamento do cisto da glândula de Bartholin comlaser de CO2

ABSTRACT Objective To describe the results of treatment with CO2 laser for Bartholin gland cysts. Methods Thirty-one women with Bartholin gland cysts were treated with CO2laser at an outpatient´s setting. Skin incision was performed with focused laser beam, the capsule was opened to drain mucoid content, followed by internal vaporization of impaired capsule. Results There were no complications. Five patients had recurrence of the cyst and were submitted to a second and successful session. Conclusion CO2 laser surgery was effective to treat Bartholin gland cysts with minimal or no complications, and can be performed at an outpatient´s setting.

RESUMO Objetivo Descrever os resultados do tratamento com laser de CO2 para o cisto da glândula de Bartholin. Métodos Foram tratadas 31 mulheres com cisto da glândula de Bartholin em regime ambulatorial com o laser de CO2. Foram realizados: incisão da pele com feixe de laser focalizado, abertura da cápsula com drenagem do conteúdo mucoide e vaporização interna da cápsula doente. Resultados Não ocorreram complicações. Cinco pacientes apresentaram recidiva do cisto, sendo submetidas à segunda sessão, com sucesso em todas. Conclusão A cirurgia com laser de CO2 foi efetiva para o tratamento do cisto da glândula de Bartholin, com mínima ou nenhuma complicação, podendo ser realizada em ambiente ambulatorial.

Bartholin's gland cysts: management with carbon-dioxide laser vaporization / Cistos da glândula de Bartholin: tratamento com vaporização laser com CO2

PURPOSE: To evaluate the effectiveness, recurrence rate, and complications of carbon-dioxide laser vaporization in the treatment of Bartholin's gland cysts. METHODS: A retrospective study including 127 patients with symptomatic Bartholin' gland cysts submitted to carbon-dioxide laser vaporization at our institution from January 2005 to June 2011. Patients with Bartholin's gland abscesses and those suspected of having neoplasia were excluded. All procedures were performed in an outpatient setting under local anaesthesia. Clinical records were reviewed for demographic characteristics, anatomic parameters, intraoperative and postoperative complications, and follow-up data. Data were stored and analyzed in Microsoft Excel® 2007 software. A descriptive statistical analysis was performed, and its results were expressed as frequency (percentage) or mean±standard deviation. Complication, recurrence, and cure rates were calculated. RESULTS: The mean age of the patients was 37.3±9.5 years-old (range from 18 to 61 years-old). Seventy percent (n=85) of them were multiparous. The most common symptom was pain and 47.2% (n=60) of patients had a history of previous medical and/or surgical treatment for Bartholin's gland abscesses. Mean cyst size was 2.7±0.9 cm. There were three (2.4%) cases of minor intraoperative bleeding. Overall, there were 17 (13.4%) recurrences within a mean of 14.6 months (range from 1 to 56 months): ten Bartholin's gland abscesses and seven recurrent cysts requiring reintervention. The cure rate after single laser treatment was 86.6%. Among the five patients with recurrent disease that had a second laser procedure, the cure rate was 100%. CONCLUSIONS: At this institution, carbon-dioxide laser vaporization seems to be a safe and effective procedure for the treatment of Bartholin's gland cysts.

OBJETIVO: Avaliar a eficácia, a taxa de recorrência e as complicações da vaporização laser com CO2 no tratamento dos cistos da glândula de Bartholin. MÉTODOS: Estudo retrospectivo com 127 pacientes que apresentavam cistos sintomáticos da glândula de Bartholin submetidas à vaporização laser CO2 na nossa instituição de janeiro de 2005 a junho de 2011. Foram excluídas todas as pacientes com abcessos da glândula de Bartholin ou com suspeita de câncer. Todos os procedimentos foram realizados em regime ambulatorial, sob anestesia local. A coleta dos dados foi feita com base na consulta do processo clínico, tendo-se procedido à análise das características demográficas, dos parâmetros anatômicos, das complicações intra e pós-operatórias e dos dados de acompanhamento. Os dados foram armazenados e analisados no software Microsoft Excel® 2007, e os resultados foram apresentados como frequência (porcentagem) ou média±desvio padrão. As taxas de complicações, recorrência e cura foram calculadas. RESULTADOS: A idade média das pacientes foi de 37,3±9,5 anos (variando entre 18 e 61 anos). Setenta por cento (n=85) delas eram multíparas. A queixa mais frequente foi dor e 47,2% (n=60) das pacientes tinham antecedentes de tratamento médico e/ou cirúrgico por abcesso da glândula de Bartholin. A dimensão média dos cistos foi de 2,7±0,9 cm. Foram verificados três (2,4%) casos de hemorragia intraoperatória ligeira e 17 (13,4%) recorrências durante um período médio de 14,6 meses (variando entre 1 e 56 meses): dez abscessos da glândula de Bartholin e sete cistos recorrentes, que precisavam de uma nova intervenção cirúrgica. A taxa de cura após um único tratamento à laser foi de 86,6%. Dentre as cinco pacientes com doença recorrente que foram submetidas a um segundo procedimento com laser, a taxa de cura foi de 100%. CONCLUSÕES: Na presente instituição, a vaporização laser com CO2 parece ser uma opção terapêutica segura e eficaz no tratamento dos cistos da glândula de Bartholin.

Hiperplasia nodular da glândula de Bartholin: relato de casos e revisão da literatura / Nodular hyperplasia of Bartholin's gland: case reports and literature review

The Bartholin's gland (BG) may develop several tumoral lesions such as BG duct cysts, carcinomas, hyperplasias, and adenomas. BG nodular hyperplasias (NHs) are uncommon, and few cases have been reported in the literature. Specific criteria for the distinction between adenomas and hyperplasias have been recently established. Several questions on possible etiologies and appropriate medical approach still remain. Therefore, this work comprises three case reports of NH and an extensive literature review.

A glândula de Bartholin (GB) pode ser sede de várias lesões tumorais, como cistos do ducto da GB, carcinomas, hiperplasias e adenomas. A hiperplasia nodular (HN) da GB é uma lesão rara e poucos casos foram relatados na literatura. Recentemente, critérios específicos estabeleceram a diferenciação entre adenomas e hiperplasias. Muitas dúvidas ainda permanecem sobre as possíveis etiologias e a conduta ideal ante essa lesão. Diante disso, o presente trabalho realizou o relato de três casos de HN e ampla revisão sobre o tema.

Quiste gigante de la glándula de Bartolino: reporte de caso y revisión de la literatura / A case report and literature review regarding giant Bartholin gland cyst

Introducción: en el presente artículo se expone el caso de una paciente que tuvo un quiste gigante de la glándula de Bartolino, el cual alcanzó un diámetro de 10 cm. La paciente presentó algunas dificultades diagnósticas y terapéuticas por lo que fue necesaria la escisión de la glándula y la posterior reconstrucción de la vulva. El diagnóstico definitivo fue establecido por anatomía patológica. El caso se presenta con el objetivo de realizar una revisión de la literatura respecto al tratamiento. Materiales y métodos: se realizó una búsqueda de la literatura relacionada con el tema en las bases de datos electrónicas PubMed, SciELO, ScienceDirect y MD Consult, utilizando las palabras clave: "glándulas de Bartolino", "quistes" y "marsupialización". Además, se revisaron referencias de libros de textos. Conclusiones: la urgencia en el tratamiento depende de los síntomas de la paciente. Un quiste asintomático podría no requerir tratamiento. Sin embargo, la no mejoría dentro de las primeras 72 horas o la evolución hacia una forma de absceso requerirá un tratamiento quirúrgico de emergencia. Se ha descrito una amplia variedad de tratamientos que incluyen una serie de procedimientos quirúrgicos tales como: 1) incisión simple y drenaje, 2) fistulización o marsupialización, 3) colocación de un catéter de Word, 4) escleroterapia con alcohol, 5) aplicación de nitrato de plata y 6) ablación del quiste utilizando dióxido de carbono (CO2 ) con láser.

Introduction: the case of a patient who had a giant Bartholin gland cyst is presented; it reached 10 cm diameter, presenting some diagnostic and therapeutic difficulties, requiring the excision of the gland and later reconstruction of the vulva. Definitive diagnosis was established by pathological anatomy. The case is presented as it led to a review of the pertinent literature regarding the relevant treatment. Materials and methods: a search was made of the pertinent literature in PubMed, SciELO, ScienceDirect and MD Consult databases, using the key words "Bartholin glands", "cysts", "marsupialization". Pertinent reference books were also reviewed. Conclusions: the urgency of treatment depends on a particular patient's treatment. An asymptomatic cyst may not require treatment; however, if there is no improvement within the first 72 hours or it evolves towards an abscess, then it will require emergency surgical treatment. A broad variety of treatments has been described which includes a series of surgical procedures, which include: simple incision and drainage, fistulization or marsupialization, placing a Word catheter, sclerotherapy with alcohol, applying silver nitrate and cyst ablation using carbon dioxide (CO2) laser.