Bartholin gland carcinoma

Vulva
Malignant neoplasms
Bartholin gland carcinoma

Author: Priya Nagarajan, M.D., Ph.D. (see Authors page)
Editor: Sara Peters, Ph.D., M.D.

Revised: 5 October 2017, last major update March 2014

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: "Bartholin's gland carcinoma" vulva

Table of Contents

Cite this page: Nagarajan, P. Bartholin gland carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/vulvabartholinglandcarc.html. Accessed July 16th, 2018.

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

Radiology images

Images hosted on other servers:

Transvaginal ultrasonography

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

Images hosted on other servers:

Irregular solid tumor with ulceration

Swelling on the right aspect of vulva

Gross images

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Bartholin gland tumor

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)