Adenoid cystic carcinoma of Bartholin's gland

International Journal of Gynecology & Obstetrics 54 (1996) 279-280

Letter to the editor

Adenoid cystic carcinoma of Bartholin’s gland Y. Morita*, S. Hikage, M. Ogino Department of Obstetrics and Gynecology, Tokyo Metropolitan Police Hospital, Tokyo, Japan Received 8 March 1996;accepted 12 April 1996

Keywords:

Adenoid cystic carcinoma; Bartholin’s

gland; Radical vulvectomy

Adenoid cystic carcinoma is a malignant epithelial neoplasm that commonly involves the salivary glands and upper respiratory tract. Involvement of Bartholin’s gland by this tumor is very rare. This tumor is characterized by slow growth, local invasion, and sometimes, distant metastasis.There is no consensuson its treatment. Treatment by wide dissection or radical vulvectomy has been reported [ 1,2]. We observed a 49-year-old Japanese woman (para II, gravida II) with a swelling on the left side of her vagina that had been present for 2 years, and which then showed an increase in size. Examination on 3 July 1995showed an elevated, firm lesion measuring 2 cm in diameter in the area of the left Bartholin’s gland. A punch biopsy suggesteda malignant epithelial tumor of Bartholin’s gland. There was no inguinal adenopathy and the pelvic examination was unremarkable. On 13 July 1995, the patient underwent a left radical vulvectomy with bilateral inguinal lymphadenectomy. Micro* Corresponding author, Tel.: +81 3 32631371;Fax: +81 3 52766899.

scopically, we observed an infiltrating adenocarcinema that was composed of small to mediumsized cells that had grown into the subcutis and that showed a cribriform pattern (Fig. 1). A few mitoses were found. The margins of the resected area were free of tumor. Focal immunoreactive positivity for smooth muscle actin and SlOOprotein identified the peripheral myoepithelial cell. The histopathologic diagnosis was adenoid cystic carcinoma stage II (pT2pNOpMO), according to the classification of the International Federation of Gynecologists and Obstetricians. A comprehensive examination performed postoperatively, including the nasopharyngeal area and gastrointestinal tract, revealed no abnormalities. The patient remains free of recurrence or metastasis 7 months postoperatively. Primary carcinoma of Bartholin’s gland constitutes lessthan 1%of the neoplasmsof the female genital tract. Such carcinomas are histologically classified as squamous cell carcinoma, adenocarcinema or adenoid cystic carcinoma amongst others [3]. They are thought to be slow-growing tumors that often exhibit local invasion and

0020-7292/96/s15.00 0 1996International Federation of Gynecology and Obstetrics PII SOO20-7292(96)02703-S

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Journal of Gynecology & Obstetrics 54 (19%) 279-280

metastasis to the lung [2]. Adenoid cystic carcinoma of Bartholin’s gland is very rare. To confirm the diagnosis, one must exclude metastasis from another region such as the salivary glands, oral cavity or nasopharynx. The appropriate treatment has not been resolved and the effectivenessof irradiation or chemotherapy has not been established.Radical vulvectomy or wide dissection is recommendedif tumor invasion is limited, as in the present case.The collection and evaluation of data on such caseswould be extremely useful in identifying the optimal form of treatment. RefeVI Bernstein SG, Voet RL, Lifshitz S, Buchsbaum HJ. Ade-

noid cystic carcinoma of Bartholin’s gland. Am J Obstet Gynecol 1983; 147: 385. PI RosenbergP, SimonsenE, Risberg B. Adenoid cystic carcinoma of Bartholin’s gland: a report of Eve new cases treated with surgery and radiotherapy. Gynecol Oncol 1989;34: 145. [31 Copeland LJ, SneigeN, GershensonDM, McGutTeeVB, AbduKarim F, Rutledge FN. Bartholin gkand carcinoma. Obstet Gynecol 1986;7: 794.

Fig. 1. Photomicrograph of the vulvar tumor showing a cribriform pattern. Interstitial invasion is prominent (H&E x200).