Bartholin's gland carcinoma

Bartholin's Gland Carcinoma: A Rare Malignancy

Bartholin's gland carcinoma (BGC) is a rare and aggressive type of cancer that affects the Bartholin glands, which are small pea-sized glands located on either side of the vaginal opening. This malignancy accounts for approximately 5% of all vulval cancers, making it an extremely rare condition.

Clinical Features

The clinical features of BGC typically include:

• A painless mass or lump near the introitus (vaginal opening)
• The mass may be big or small, and can appear deep under skin or nearer the surface with overlying ulceration
• Itching, bleeding, and other symptoms may also occur in some cases

Demographics

BGC more commonly occurs in post-menopausal women, with a median age at diagnosis of 57 years old. This is significantly earlier than the age for non-BGC vulvar cancers.

Types of Carcinoma

Primary carcinoma of the Bartholin's gland can be either adenocarcinoma or squamous cell carcinoma, although other types may also occur.

Diagnosis and Management

A biopsy is typically needed to confirm the diagnosis of BGC. Treatment options include marsupialization, gland excision, or a combination of these procedures. It is essential for specialized gynecological oncologists at referral centers to manage these tumors.

References

• [2] Bartholin gland carcinoma presents with a painless mass at one side of the vaginal opening in a female of middle-age and older.
• [6] BGC accounts for approximately 5% of all vulval malignancies—making it an extremely rare malignancy of the female genital tract.
• [13] BGC commonly manifests as a painless unilateral mass, near the introitus.
• [14] Primary carcinoma of the Bartholin's gland is a very rare malignancy of the vulva.

Warning Signs and Symptoms of Bartholin's Gland Carcinoma

Bartholin's gland carcinoma, a type of cancer that develops in the Bartholin glands located on either side of the vaginal opening, can manifest with various symptoms. While some cases may be asymptomatic, others may present with noticeable warning signs.

• Painless mass: A painless lump or mass at one side of the vaginal opening is a common presentation of Bartholin's gland carcinoma (2). The mass may be small or large and can appear deep under the skin or nearer the surface with overlying ulceration (2).
• Lump on either side of the vagina: A distinct mass (lump) on either side of the opening to the vagina can be a sign of Bartholin gland carcinoma, although this is more commonly associated with a Bartholin cyst, which is not cancerous (9).
• Non-specific localized symptoms: Less often, Bartholin's gland carcinoma may be associated with non-specific localised symptoms such as pain, bleeding, pruritis, or dyspareunia (3).

It is essential to note that these symptoms can also be indicative of other conditions, and a definitive diagnosis can only be made through medical examination and testing.

References:

• [2] - A type of cancer of the vulva arising in the Bartholin gland.
• [9] - A lump in this area is from a Bartholin gland cyst, which is much more common (and is not a cancer).
• [3] - Less often, a BGC may be associated with non-specific localised symptoms of pain, bleeding, pruritis, or dyspareunia.

The differential diagnosis for Bartholin's gland carcinoma includes several conditions that can mimic or be confused with this rare malignancy.

Common Differential Diagnoses

• Bartholin gland cysts and abscesses: These are benign conditions that can present similarly to a tumor, but are typically smaller in size and may not have the same aggressive characteristics as a carcinoma.
• Vulvar endometriosis: This is a condition where tissue similar to the lining of the uterus grows outside the uterus, which can cause symptoms such as pain and bleeding.
• Syphilis and chancroid: These are infectious diseases that can cause ulcers or lesions on the vulva, which may be mistaken for a tumor.
• Vulvar melanoma, sarcoma, and squamous cell carcinoma of the overlying skin: These are other types of cancer that can occur in the vulva and may be confused with Bartholin's gland carcinoma.

Rare Variants

• Adenoid cystic carcinoma (ACC): This is a rare variant of vulvar malignancies that represents only 10-15% of cases. It is characterized by its aggressive behavior and poor prognosis.
• Squamous cell carcinoma: This is another type of cancer that can occur in the Bartholin gland, although it is less common than adenoid cystic carcinoma.

Key Points to Consider

• The differential diagnosis for Bartholin's gland carcinoma is broad and includes both benign and malignant conditions.
• A thorough examination and histological evaluation are essential to distinguish between these conditions and determine the correct diagnosis.
• The prognosis for Bartholin's gland carcinoma is generally poor due to its aggressive metastatic tendencies.

References:

[2] "Bartholin gland carcinoma – Primary carcinoma of the Bartholin gland is most often an adenocarcinoma or squamous cell carcinoma, but transitional cell, adenosquamous, and adenoid cystic carcinomas may also occur."

[4] "Biopsy is an effective method for distinguishing between Bartholin's gland cysts and differential diagnosis. While smaller cysts may be asymptomatic and may be left untreated, larger cysts require medical attention."

[10] "The differential diagnosis of Bartholin gland carcinomas includes benign etiologies, such as Bartholin gland abscess, cyst or vulvar endometriosis; infectious etiologies such as syphilis and chancroid; and other vulvar cancers such as vulvar melanoma, sarcoma and squamous cell carcinoma of the overlying skin."

[12] "The differential diagnosis of Bartholin gland carcinomas includes benign etiologies, such as Bartholin gland abscess, cyst or vulvar endometriosis; infectious etiologies such as syphilis and chancroid; and other vulvar cancers such as vulvar melanoma, sarcoma and squamous cell carcinoma of the overlying skin."

[13] "The histological type of Bartholin gland cancer was specified in 90.4% cases: 30.7% cases were squamous cell carcinoma, 29.6% adenoid cystic carcinoma, 25% adenocarcinomas."