Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2010  |  Volume : 53  |  Issue : 1  |  Page : 171--172

Bartholin gland carcinoma


Geetika Khanna1, Rajni1, Kalpana Azad2,  
1 Department of Pathology, CIO Laboratory, New Delhi, India
2 V.M.M.C and Safdarjung Hospital, New Delhi, India

Correspondence Address:
Geetika Khanna
House No-88, sector 37, Noida, U.P - 201 303
India




How to cite this article:
Khanna G, Rajni, Azad K. Bartholin gland carcinoma.Indian J Pathol Microbiol 2010;53:171-172


How to cite this URL:
Khanna G, Rajni, Azad K. Bartholin gland carcinoma. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Oct 27 ];53:171-172
Available from: https://www.ijpmonline.org/text.asp?2010/53/1/171/59221


Full Text

Sir,

Primary carcinoma of Bartholin gland is rare, accounting for two to seven per cent of all vulval carcinoma and 0.001% of all female genital tract malignancies. [1] Various histological types of primary bartholin gland carcinoma are described. Adenocarcinoma comprises approximately 40% of all cases of bartholin gland carcinoma and a similar number are squamous cell carcinoma. [2] The remaining cases include adenoid cystic carcinoma, undifferentiated carcinoma and adenosquamous carcinoma. [2] Adenosquamous carcinoma is a rarely encountered histologic sub-type of bartholin gland carcinoma. Extensive comedo necrosis in an adenosquamous bartholin gland carcinoma is even more unusually described.

A 55-year-old woman presented with complaints of swelling in left labia majora associated with intermittent pain, pruritus and bleeding since three years. Local examination revealed a five cm nodular growth in the inner postero-lateral region of left labia majora. Bilateral inguinal lymphadenopathy was also observed. The overlying skin was ulcerated. Fine needle aspiration cytology was reported as suggestive of an adenosquamous carcinoma. Simple vulvectomy was done with adequate tumor resection and vulvar reconstruction. Histologically, a mixed adenosquamous pattern with extensive comedo necrosis was seen [Figure 1]. On electron microscopy, dark and light secretory granules confirmed bartholin gland origin of the tumor [Figure 2].

Carcinoma of bartholin gland is often unsuspected but should be considered in older women who have a large ulcerated lesion located in the anatomical region of the gland, [2] especially if intraepithelial neoplastic changes of the adjacent skin and anus are absent. A clinical suspicion of bartholin gland carcinoma should be followed by fine needle aspiration cytology as advocated by Dodson et al. [3] It is recommended that a definite histological diagnosis of a bartholin gland neoplasm should be made only when an area of transition from normal gland or duct tissue to neoplastic tissue is identified. However, it may be impossible to determine the exact origin of extensive, deeply invasive lesions, in which the residual normal gland gets completely obliterated.

A delay in appropriate management of bartholin gland carcinoma is frequently due to its misdiagnosis as a cyst or an abscess, when it is small and a primary vulval carcinoma when it is large. The ultimate evidence of Bartholin gland origin of the tumor comes from electron microscopy, which if available, must be resorted to, for accurate preoperative diagnosis. [4] Adenosquamous variant has a poorer prognosis than a squamous cell variant. This poor prognosis is attributed to a higher frequency of lymph node metastasis. [5] The standard treatment for carcinoma of bartholin gland is wide local excision, ipsilateral or bilateral lymphadenectomy and radiation therapy.

References

1Barclay DL, Collins CR, Macey HB Jr. Cancer of the Bartholin gland: A review and report of eight cases. Obstet Gynecol 1964;24:329-35.
2Stolen MH, Mills SE, Frierson HF. The vulva and vagina. In: Mills SE, Carter D, Greensan JK, et al. editors. Sternberg's Diagnostic Surgical Pathology. 4th ed. Philadelphia: Lippincott; 2004. p. 2579-616.
3Dodson MG, O'Leary JA, Averette HE. Primary Carcinoma of Bartholin gland. Obstet Gynecol 1970;37:578-84.
4Advani H, Waldo ED, Bigelow B. Bartholin gland carcinoma: An ultrastructural study. Am J Obstet Gynecol 1978;13:362-4.
5Underwood JW, Adcock LL, Okagaki T. Adenosquamous carcinoma of skin appendages (adenoid squamous cell carcinoma, pseudo- glandular squamous cell carcinoma, adenoacanthoma of sweat gland of Lever) of vulva: A clinical and ultrastructural study. Cancer 1978;42:1851-8.