Table of Contents
Definition / general | Epidemiology | Sites | Pathophysiology | Clinical features | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Clinical images | Gross images | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Electron microscopy description | Electron microscopy images | Differential diagnosis | Additional referencesCite this page: Nagarajan P, Peters SB. Bartholin gland carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvabartholinglandcarc.html. Accessed December 8th, 2019.
Definition / general
- First documented in 1864
- Often diagnosed at advanced stage due to late presentation and low clinical suspicion
- Diagnostic criteria: (Obstet Gynecol 1972;39:489; Best Pract Res Clin Obstet Gynaecol 2003;17:609)
- Compatible with origin from Bartholin gland, deep to the labia
- Intact overlying skin
- Transition between normal glandular tissue and carcinoma
- No evidence of primary tumor elsewhere
Epidemiology
- Mean age at diagnosis: 60 years (range 33 - 93 years)
- Constitutes approximately 2 - 7% of vulvar and less than 1% of gynecologic malignancies (Surg Oncol 2013;22:117)
Sites
- Posterolateral to labium majus, involving the lower part of the vulva
Pathophysiology
- Human papillomavirus (HPV) infection has been identified as a major contributing factor in the development of squamous cell carcinoma of the Bartholin gland (Histopathology 2000;37:87)
Clinical features
- Slow growing, painless, palpable or visible tumor posterior to the labium majus
- Rarely, patients may experience rectal or vaginal pain and discomfort, bleeding (postcoital), dyspareunia and pruritus
Radiology description
- Ultrasound: (J Diag Med Son 2010;26:296)
- Echogenic mass that may contain calcifications
- MRI: (Surg Oncol 2013;22:117)
- T1 weighted: mass isotense to skeletal muscle
- T2 weighted: enhancement with gadolinium
- CT scan: (Surg Oncol 2013;22:117)
- Indicated for any vulvar mass more than 2 cm in size
- Also useful in detecting possible nodal spread
- F18 FDG PET / CT: (Clin Nucl Med 2007;32:498)
- Though the role of a PET / CT is not clear, it is essential for staging
Prognostic factors
- Size and stage at the time diagnosis are the most important prognostic factors (J Clin Oncol 2008;26:884)
- Larger size of the nodal metastasis and the presence of extracapsular invasion are also poor prognostic indicators (Gynecol Oncol 1992;45:313)
Case reports
- 36 year old woman with adenoid cystic carcinoma of the Bartholin gland (Eur J Gynaecol Oncol 2009;30:686)
- 49 year old woman with Merkel cell carcinoma of the Bartholin gland (Gynecol Oncol 2005;97:928)
- 54 year old woman with adenoid cystic carcinoma of Bartholin gland (Gynecol Obstet Invest 2005;59:54)
- 64 year old woman with adenoid cystic carcinoma of the Bartholin gland (Arch Gynecol Obstet 2008;278:473)
- 68 year old woman with chemoradiotherapy with irinotecan (CPT 11) for adenoid cystic carcinoma of Bartholin gland (Gynecol Oncol Case Rep 2012;4:16)
- 73 year old woman with vulvar mass (Case of the Week #172)
- 92 year old woman with mucinous adenocarcinoma of Bartholin gland treated with radiation therapy (Jpn J Clin Oncol 2001;31:226)
- Bartholin gland squamous cell carcinoma (J Obstet Gynaecol 2012;32:318)
Treatment
- Surgical resection: (Surg Oncol 2013;22:117)
- Tumors < 2 cm: hemivulvectomy
- Tumors > 2 cm: total vulvectomy, with bilateral inguinal and femoral lymphadenectomy
- Partial pelvic exenteration may be needed for large tumors
- Adjuvant radiation therapy
Clinical images
Microscopic (histologic) description
- Histology of the carcinoma varies based on site of origin
- Squamous cell carcinomas (SCC) and adenocarcinomas are the most common malignant tumors arising from the Bartholin gland (~40% each), followed by adenoid cystic carcinoma (ACC, ~15%)
- Other histological types (~5%) include:
- Transitional cell carcinoma, adenosquamous carcinoma, poorly differentiated carcinoma, low grade epithelial - myoepithelial carcinoma, sarcoma, melanoma and clear cell carcinoma
- Squamous cell carcinoma:
- Usually arises from vestibular duct orifice or at transition zone (J Obstet Gynaecol 2012;32:318)
- Human papillomavirus (HPV) infection has been identified as a major contributing factor in its carcinogenesis (Am J Pathol 1993;142:925, Int J Gynecol Pathol 2009;28:497, Histopathology 2000;37:87)
- Usually well differentiated, composed of polygonal eosinophilic, keratinizing cells with intercellular bridges
- Keratin pearls are frequently noted in well differentiated tumors
- Adenocarcinoma:
- Frequently arises at transition zone or from mucin producing acini (Jpn J Clin Oncol 2001;31:226)
- Composed of columnar to cuboidal cells containing intracellular mucin
- Pools of extravasated mucin may also be present
- Adenoid cystic carcinoma:
- May originate from myoepithelial cells
- Tumor cells usually have low cytologic grade and are arranged in a cribriform pattern and the (pseudo) lumens are filled with mucin or hyalinized basement membrane material
- Because of its tendency for extensive perineural invasion, ACC is associated with frequent local recurrence (Arch Gynecol Obstet 2008;278:473, Gynecol Oncol Case Rep 2012;4:16)
Microscopic (histologic) images
Images hosted on PathOut server:
Case of the Week #172:
Images hosted on other servers:
Adenocarcinoma:
Squamous cell carcinoma:
Positive stains
Electron microscopy description
- Not commonly performed; usually only to confirm organ of origin rather than type of tumor (Indian J Pathol Microbiol 2010;53:171)
Electron microscopy images
Differential diagnosis
Additional references
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