Smooth muscle neoplasms of the vulva masquerading as Bartholin gland duct cysts

Abstract

Smooth muscle neoplasms of the vulva can be mistaken for Bartholin duct cysts, which can lead to a delay in diagnosis. We present a case of vulvar leiomyoma and a case of leiomyosarcoma that clinically mimicked Bartholin duct cysts. Identification of leiomyosarcomas in this region is particularly important; due to the risk of recurrence, patients may need radiation and/or chemotherapy in addition to adequate surgical treatment and appropriate follow up. Prior series have shown that risk of recurrence is related to inadequate resection and not to the size or grade of tumor. It is critical that pathologists recognize smooth muscle tumors of the vulva and communicate to clinicians the importance of clear margins and wide local excision in cases of malignancy.

Figure 1.

The leiomyoma in patient 1 (a) displays interweaving fascicles of bland spindle cells with minimal to no cytologic atypia (hematoxylin and eosin, × 200) and (b) has a diffusely positive stain for smooth muscle actin by immunohistochemistry, classifying the tumor as a leiomyoma (immunohistochemical stain, × 200).

Figure 2.

The leiomyosarcoma in patient 2 displays (a) diffuse nuclear pleomorphism with hyperchromatic, enlarged, and atypical nuclei (hematoxylin and eosin, × 400) and (b) increased mitotic activity (up to 16 mitoses per 10 high-power fields with atypical forms) (hematoxylin and eosin, × 200).