Adenoid Cystic Carcinoma of Bartholin’s Gland Misdiagnosed as Benign Vulvar Adnexal Tumour

Abstract

Adenoid cystic carcinoma of the Bartholin’s gland accounts for < 1% of all female genital malignancies and 1–7% of all vulvar carcinomas. These tumours are slow growing and characterized by perineural and lymphatic invasion leading to pain and recurrence seen with this tumour. Adenoid cystic carcinoma of the Bartholin’s gland is rare, and the diagnosis may be delayed or missed by both the clinicians and pathologists as in this case. Persistent perineal pain along with a vulvar mass should raise the suspicion. We report a case of adenoid cystic carcinoma of Bartholin’s gland misdiagnosed as a benign vulvar adnexal tumour at initial evaluation and biopsy. The patient had persistence of pain due to which she returned to her physician 1 year later. At that time, a histopathological review of the previous biopsy was done which revealed adenoid cystic carcinoma of the Bartholin’s gland. The patient was treated with radical vulvectomy with ipsilateral inguinofemoral lymphadenectomy. The entire Bartholin’s gland was excised by dissecting deep into the ischiorectal fossa. Part of the distal vagina was also excised. Patient was given post-operative external beam radiotherapy with concurrent chemotherapy with carboplatin. A high index of suspicion is required to avoid delay in diagnosis and management. A deep and wide dissection in the ischiorectal fossa is necessary for complete excision of the tumour.