Bartholin's Duct Research Articles

Comparison of the distribution of the Bartholin and/or Rivinus salivary ducts assessed with magnetic resonance-sialography in patients with ranula and in healthy subjects.

The distribution and drainage of the sublingual gland ducts have various patterns that might be related to sublingual gland-related diseases, including ranula. This study aimed to elucidate the characteristics of the distribution of Bartholin and/or Rivinus ducts in patients with ranula using magnetic resonance (MR) sialography. In this retrospective cross-sectional study, the distributions and drainage patterns of sublingual gland ducts on MR sialography were classified in 74 subjects without sublingual gland-related disease as confirmed by both medical history and clinical examination and 15 patients with ranula, respectively. All patients had visited Kyushu Dental University Hospital from July 2015 to June 2022 to undergo MR imaging. Data on the distributions and drainage patterns of the sublingual gland ducts, including the characteristics of the Bartholin and/or Rivinus ducts, were then statistically compared between subjects without sublingual gland-related disease and patients with ranula. The images were assessed by an experienced oral and maxillofacial radiology specialist certified by the Japanese Society for Oral and Maxillofacial Radiology. The distributions (five groups) and drainage patterns (three patterns) of the sublingual gland ducts on MR sialography were classified in reference to previous studies, with some modifications in all subjects without sublingual gland-related disease and patients with ranula. A significant difference in the distribution of the ducts (P<0.001), with a low number of patients exposing an undetected canal or Rivinius duct, was found in the group of patients with ranula (P<0.05). Regarding drainage patterns, no patient with ranula presented a Rivinius duct only. A significant difference in the drainage patterns of the sublingual gland ducts on MR sialography was observed between subjects without sublingual gland-related disease and patients with ranula (P=0.001). The present results suggest that the distribution of the sublingual gland ducts, mainly, the Bartholin duct, may be related to ranula formation. These findings also demonstrate that MR sialography contributes well to preoperative evaluation and is effective for assessing the complex excretory distribution of the sublingual gland ducts.

Experience of surgical treatment of Bartholin duct cysts in outpatient department

Experience of surgical treatment of Bartholin duct cysts in outpatient department

Bartholin Duct Cyst and Nodular Hyperplasia: A Clinicopathological Study of 32 Patients.

Background: Inflammatory lesions and cysts are the most common Bartholin glands pathologic diagnoses. There have been very few reports of benign solid lesions of Bartholin glands such as nodular hyperplasia. Materials and methods: Thirty-two lesions diagnosed as Bartholin duct cyst in the gynecologic specialized institute were reviewed by two expert gynecological pathologists. Results: Using specific criteria, 7 qualified as nodular hyperplasia, 25 as Bartholin duct cyst. The average age of the patients with nodular hyperplasia was 31 years (range, 24 to 43). These lesions were solid, solid and cystic or purely cystic, had a mean maximal dimension of 3.3 cm, and were frequently thought to be Bartholin cysts on clinical examination. Four lesions were diagnosed as Bartholin duct cysts, while in the review they were considered as nodular hyperplasia. Conclusion: Nodular hyperplasia of Bartholin gland may be more common than is reported in the literature. This study showed that the diagnosis of nodular hyperplasia has been overlooked due to limited literature sources.

(031) Bartholin Cysts Can Be Treatable Causes of Female Sexual Dysfunction: Four Year Review of Diagnosis and Treatment Principles

Abstract Introduction Bartholin glands are major vestibular androgen dependent glands that release mucus secretions during sexual arousal through a 2.5 cm duct that drains at the 5 o'clock and 7 o'clock positions of the vestibule. Bartholin's glands are innervated by a branch of the pudendal nerve; mucous secretion is activated by the efferent pelvic nerve. Unilateral or bilateral obstruction of the Bartholin's ducts may occur (e.g. from trauma, infection, surgery, or idiopathic), however as long as innervation is intact, Bartholin glands continue to produce mucus despite outlet ductal occlusion. This leads to dilation of the duct with subsequent cyst formation that can result in Bartholin cyst-associated sexual dysfunction symptoms. Objectives To review patient records of women presenting to a sexual medicine clinic over a four-year period diagnosed with and surgically treated for Bartholin cyst-associated sexual dysfunction. Methods Grayscale ultrasound was performed (see figure) using the Aixplorer and cyst dimensions were measured after visual sexual stimulation in the office. Vulvoscopy was performed with the Wallach Zoomscope. Bartholin cyst anesthesia testing was performed using benzocaine 20%, lidocaine 8% and tetracaine 6%. Marsupialization surgery was performed as an out-patient. Results We identified 11 patients (mean age 26 +/− 6 years) diagnosed with Bartholin cyst-associated sexual dysfunction between January 2019 and November. 2010 who met inclusion criteria and were surgically treated by marsupialization for unilateral (4) and bilateral (7) Bartholin cysts. Their symptoms of Bartholin cyst-associated sexual dysfunction included dryness with sexual arousal (73%), pain with sexual arousal (82%), pain with orgasm (36%), spontaneous drainage (18%), and a mass at the introitus interfering with penetration (45%). 55% had been treated previously at other facilities unsuccessfully, including cyst aspiration, Word catheter placement, and marsupialization. The mean cyst size on ultrasound was 2.9 +/− 1.5 cm. Bartholin cyst anesthesia testing was positive in all (4/4) that underwent this test. Surgical principles to encourage post-op mucin drainage through the Bartholin duct included visualization of the duct at surgery (see figure) and direct anastomosis of the duct to the inferior portion of the incision at 5 and/or 7 o’clock locations (see figure). Post-operative daily arousal was encouraged and mucin secretion through the marsupialized ducts was documented by placement of gauze in the introitus and observing the mucous (see figure). At the time of this review, with an average follow-up of 8 months, 15 of 18 (83%) cysts are still draining and 9/11 patients are somewhat better, much better and very much better with resolution of Bartholin cyst-associated sexual dysfunction symptoms. Conclusions Bartholin cysts are a sexual dysfunction that can be successfully treated. Diagnosis involves an ultrasound after sexual arousal and a positive Bartholin cyst anesthesia test. Treatment involves marsupialization with visualization and anastomosis of the Bartholin duct to the inferior portion of the incision at the 5:00 and 7:00 locations. Post-operative daily arousal is encouraged with documentation of mucinous drainage detected. Disclosure No.

(130) Marsupialization of the Bartholin Duct Cyst and Recanalization for Symptomatic Recurrent Bartholin Cysts

Abstract Introduction Bartholin glands (BGs) are located posteriorly on each side of the vaginal introitus. During sexual arousal, BGs release mucinous secretions into the vestibule at the 5:00 and 7:00 positions via a 2.5 cm Bartholin duct (BD). The BD may become obstructed from trauma, inflammation, infection, vestibular or vulvar surgery, or idiopathic factors. Despite BD obstruction, the glands may continue to produce mucinous secretion causing cystic dilation of the duct. Thus, a Bartholin duct cyst (BC) is formed and can result in pain during sexual arousal. Treatment strategies include sitz baths, hot compresses, aspiration, Word catheter placement, or BC marsupialization. Objective This chart review was performed to assess the safety and efficacy of a new technique for BD marsupialization in patients with symptomatic BC. Methods This is a chart review of patients with symptomatic BC who underwent BD marsupialization using a new technique. This new strategy involves marsupialization of the anterior wall of the BC, identification of the BD lumen on the posterior wall of the BC under surgical Loupes magnification and advancement of the BD lumen directly to the surface of the introitus at 5:00 and/or 7:00 locations. The BD neo-ostium was secured with interrupted 4.0 chromic sutures. Results 14 patients (mean age 28 ± 9 years) between 2015 - 2022 diagnosed with recurrent BC-induced pain during sexual arousal were treated by marsupialization of the BC and advancement of the BD directly to the mucosal surface of the introitus. Each patient averaged 3 prior BC treatments (range 0- 6). Symptoms included pain with sexual arousal or walking/sitting (100%) and an introitus mass interfering with penetration (50%). The mean BC size on ultrasound was 2.7 ± 1.6 cm x 2.4 ± 1.7 cm. All BD marsupialization surgeries were performed as outpatient procedures. Sexual arousal was encouraged early post-operatively and mucinous secretion documented by vestibular photography post-arousal. With an average follow-up of 14 months, 11/14 (79%) symptomatic BCs have resolved. Conclusions A new surgical strategy is described for patients with symptomatic BCs involving BD anastomosis directly to the introital mucosa at the 5:00 or 7:00 locations, resolution of BD obstruction, and excellent restoration of BG lubrication. Disclosure No

Editorial

Editorial

A Single Institution Cadaveric Study on Anatomical Variation of the Sublingual Gland Duct.

The purpose of this study was to conduct a cadaveric dissection study on the anatomical variation of the sublingual (SLG) excretory ducts and dictate an improved understanding of the anatomical communication between the SLG duct and submandibular (SMG) ducts. This study is carried out by standardized dissection of anterior floor of mouth in 6 formalin-fixed adult cadavers in Silent Mentor Workshop University Malaya in August 2020. The cadavers had no trace of scars, adhesions, signs of trauma or operation. SMG duct opening was identified lateral to the lingual frenulum through a papilla in the floor of mouth behind the lower incisor tooth. A horizontal incision line was done over floor of mouth just lateral to the opening. SMG duct and SLG was traced and skeletonized. Any presence of major duct arising from the SLG and its communication with SMG duct were investigated. We found there are 3 patterns of SLG excretory duct variants; (1) One major (Bartholin's) duct which open independently at its own orifice adjacent to the orifice of the Wharton's duct of SMG. (2) One major (Bartholin's) duct which joined into the Wharton's duct of SMG. (3) Absent of a major duct arising from SLG. The overall mean diameter of SLG ducts were 1.3 ± 0.41and the mean length of SLG ducts were 18.5 ± 6.55. The overall mean diameter of SMG ducts was 2.6 ± 0.74 and the mean length of SMG ducts were 46.5 ± 6.57. Excretory ductal system of SLG showed great variations, not only between the different cadavers but also within the different sides of the same cadaver. Awareness of potential anatomical variations can aid in the accurate diagnosis and treatment of patients with salivary gland pathology as well as help surgeons reveal potential risk factor and avoid complications during surgical procedures in the floor of mouth.

Recurrent Bartholin's Cyst: Literature Review and Case Report

Bartholin's cyst is a form of cystic (fluid-filled) tumor on the vulva. Bartholin's cyst is a cyst that forms due to blockage of the Bartholin's gland duct, which causes retention and cystic dilatation. Reports indicate that a 45-year-old woman came to the Obstetrics and Gynecology Polyclinic at Pertamina Bintang Amin Hospital, Malahayati Bandar Lampung, experiencing a recurrence of a left Bartholini abscess for the third time after two external incisions. The treatment carried out in this patient was given antibiotics and analgesics and it was recommended to do surgery with an extirpation procedure. Recurrent Bartholin's gland abscesses in women of reproductive age are generally associated with a risk of contact with sexually transmitted infection polymicrobials. Needle aspiration and incision and drainage are the two simplest procedures, not recommended because of the relatively increased recurrence rate.

Histopathological spectrum of vulvar lesions on a remote Indian Island

A wide spectrum of normal, benign, premalignant, and malignant lesions may occur on the vulva. Symptoms of vulvar disorders may be non-specific. Empiric treatment of vulvovaginal symptoms is common but usually not helpful. Though the varied clinical presentation and diverse histopathological spectrum of vulvar lesions have amazed Pathologists, only a few studies have been reported in the literature. The present study consists of a histopathological spectrum of vulvar lesions. 1.To evaluate the histopathological spectrum of vulvar lesions. 2. To compare the incidences of non-neoplastic and neoplastic lesions of the vulva. Present study includes all types of vulvar lesion specimens received in the Department of pathology over a period of four years. All thirty-nine vulvar biopsies received in the Department of Pathology were studied for histomorphologic features. The lesions were categorized as non-neoplastic, neoplastic. The neoplastic ones were further divided into benign, malignant, and premalignant. The age of the women ranged from 15 to 69 years (mean 36.18±12.71) with the maximum number of patients between 30 to 40 years of age. Non neoplastic lesions were more common (22; 56.4%) than the (17; 43.6%) neoplastic lesions. There were 15(38.5%) benign lesions while 2 cases (5.13%) were malignant. Among the non-neoplastic lesions, Bartholin's duct cyst was the most common histopathologic diagnosis (35.9%). The fibroepithelial polyp was the most common benign neoplastic lesion constituting 15.3%. In the present study nonneoplastic lesions were more common than neoplastic lesions. Among the neoplastic lesions, benign neoplasms were more frequent than malignant lesions.

A 19 cm Angiomyxoma of the Vulva in a 45-Year-Old Woman: A Case Report

Angiomyxoma is a rare, benign, locally infiltrative mesenchymal tumor that occurs in women at reproductive age. We present a 45-year-old female's case with a four years history of vaginal growth which has been progressively increasing in size. The patient was misdiagnosed of Bartholin's duct cysts and was asymptomatic. Aggressive angiomyxoma is a frequently misdiagnosed tumor that tends to recur locally. The prefix “aggressive” was added to emphasize this tumor characteristic. The diagnosis was based on histopathological and immuno-histochemical results. Treatment involves surgery that should aim wide local excision. However, over the years alternative treatment was proposed, in particular, hormonal therapy based on the female hormone receptors of this mesenchymal tumor. Application of imaging method, like ultrasounds, could be useful both for differential diagnosis and to evaluate the tumor before surgery. The frequent local recurrence of this disease requires a long-term follow-up.

Study of morphological structure in human fetus Wharton's duct opening area

ObjectivesNot many morphological studies have been reported regarding the human salivary main duct, especially those based on observations of the fetal salivary main duct at various developmental stages. The relationships between fetal structural development and its function, functional disorders and diseases certainly have clinical significance. MethodsIn this study, we conducted a morphological observation of seven 5–9 month old human fetal sublingual caruncula, the common opening between the submandibular (Wharton's) duct and the sublingual (Bartholin's) duct. After seven specimens were removed and paraffin sections were prepared, HE and EVG staining were used for histological study of structural differences in the various developmental stages. Furthermore, anti-α-SMA staining was used to observe the distribution of the smooth muscle inside of the Wharton's duct wall. ResultsAn abundance of elastic fibers were observed in the duct walls of both five and nine month old specimens with EVG staining. The smooth muscle fibers of five month old fetus were immature and were starting to distribute throughout the duct wall, whereas nine month old fetus’ smooth muscle fibers were further developed and composed in layers. ConclusionIn this study, we confirmed that the Wharton's duct wall structure of nine month old fetuses was close to its adult structural formation, while the inner structure consisted of an ample distribution of elastic fibers and smooth muscle fibers. Based on the distribution pattern of the smooth muscle, we speculate that the Wharton's duct's opening area does not possess a sphincter-like function in the regulation of salivary flow.

Management of Bartholin Duct Cysts and Gland Abscesses.

Bartholin duct cysts and gland abscesses can affect a woman's day-to-day functioning and be challenging to manage. Many Bartholin duct cysts that are not infected remain asymptomatic and resolve spontaneously without intervention.However, an infected Bartholin duct cyst or glandular abscess should be drained when larger than 2 cm because such cysts or abscesses do not tend to resolve spontaneously and can recur. Management options fall under 3 broad categories: expectant, medical, or surgical. With special training, midwives and women's health nurse practitioners can manage many women who present with Bartholin duct cysts or gland abscesses. Rarely, a woman with a severe or recurrent infection will need referral to a surgeon. Knowing which management option to choose may be challenging at first; this article is aimed at providing evidence-based knowledge about Bartholin duct cysts and gland abscesses for clinicians so that they can make the diagnosis and management plan with confidence. A clinical case is used to illustrate the identification, diagnosis, and management of Bartholin duct cysts and gland abscesses.The range of interventions, from expectant management with comfort measures to surgical intervention, is be explored to assist the clinician in choosing the correct management approach.

Salivary Duct Repositioning after Biopsy Surgery: a Case Series

The salivary duct of major salivary glands is often resected during treatment of obstructive lesions such as sialolithiasis and ranula or oral tumors, benign or malignant. Complications, such as postsurgical ranula, swelling, pain, and infection related to surgeries involving these ducts are commonly reported. We present a series of 4 cases of salivary duct repositioning after biopsy surgeries. Three of these cases were performed during sialolithiasis treatment, 2 in the floor of the mouth (Wharton and Bartholin ducts) and 1 in the Stensen duct. The fourth case was performed in the Stensen duct during the removal of a lesion diagnosed microscopically as white sponge nevus. All of the procedures included the removal of the excretory end of the ducts. After the biopsy procedures, the salivary flow was evaluated, and the remaining duct was repositioned, sutured to the neighboring heathy mucosa in all cases. The follow-up was satisfactory without complications.

Sublingual Gland Ranula Treatment: Case Report

Ranula are lesions resulting from leakage/extravasation of mucin into the buccal tissues, with varied etiology. The gland of origin is mainly sublingual and may be associated with the submandibular or minor salivary glands. Recurrence rates vary with the treatment as follows: incision and drainage (71-100%), excision of the ranula (0-25%), marsupialization (61-89%), excision of the ranula and associated sublingual gland (0-2%). This was the case report of a 52-year-old woman, showing a volume increase in the floor of the mouth, floating, translucent, with 6 months of evolution, without radiographic imaging, and with a clinical diagnosis of ranula. The initial approach proposed was marsupialization. Due to recurrence, sublingual gland excision was performed after 14 days. The presence of recurrence after treatment may occur due to anastomosis between the Rivinus and Bartholin ducts. The patient is in an ambulatory follow-up.

Are the patients with anatomic variation of the sublingual/Wharton's duct system predisposed to ranula formation?

ObjectiveTo evaluate ranula development according to anatomic variation of the ductal system of sublingual gland (SLG), especially the presence of Bartholin's duct. MethodsThe anatomic variation of SLG duct was prospectively investigated and compared between 55 consecutive patients with ranulas treated by SLG excision (group 1) and another 15 consecutive patients undergoing similar surgeries for other conditions (group 2). The ductal structures of SLGs and submandibular glands (SMG) were also compared between the pediatric patients and adult patients with ranulas. ResultsIn 32 of 55 patients with ranulas (58.2%) and 1 of 15 patients without ranulas (6.7%), the SLG showed an anatomic variation of the main duct called Bartholin's duct structure (P<0.01). Seventeen of 22 (77.3%) pediatric patients with ranulas had Bartholin's ducts and 15 of 33 (45.5%) adult patients with ranulas had Bartholin's ducts (0.01<P<0.05), but Bartholin's duct which opens near to the orifice of Wharton's duct was not found in this study population. Plunging ranulas that extravasate deep to the mylohyoid were observed in the 6 patients (4 children and 2 adults). There was no recurrence in all cases with ranulas. ConclusionsCongenital anatomic variation of the ductal system of the SLG might be a possible cause of ranulas in the patients with simple ranulas, especially in pediatric patients. Surgical resection of the SLG is a better treatment choice for ranulas than other conservative treatments.

Recurrent Sublingual Ranula or Saliva Leakage From the Submandibular Gland? Anatomical Consideration of the Ductal System of the Sublingual Gland

Some believe that the recurrence of sublingual ranula results from incomplete removal of the sublingual gland (SLG), but recurrence remains in some patients who undergo repeated excision of the remnant SLG, and the final solution to the recurrence is to remove the ipsilateral submandibular gland (SMG). In the authors' experience, preoperative aspirate from a sublingual ranula was a thick mucus-like fluid resembling egg white, whereas that from recurrent cyst after removal of the SLG was thin serous fluid. Based on the difference of the aspirated fluids, the authors speculated that the recurrent cystic mass might not be a ranula, but rather iatrogenic saliva leakage from the SMG through the previous surgically damaged excretory duct of the SLG (Bartholin duct) that opens into the SMG duct (Wharton duct). A gross anatomic study was performed of the ductal system of the SLG and the anatomic communication between the Bartholin duct and Wharton duct. Four anatomic SLG duct variants were found. 1) The SLG has 1 Bartholin duct that seems to fuse with the Wharton duct but does not join the Wharton duct, running parallel to the Wharton duct and opening at its own orifice adjacent to and a short distance from the orifice of the Wharton duct (35.8%). 2) The SLG has 1 Bartholin duct that empties into the middle section of the Wharton duct (32.1%). 3) The SLG has 2 Bartholin ducts, one of which joins the Wharton duct and the other opens at its own orifice near that of the Wharton duct on the floor of the mouth (7.1%). 4) The SLG has many fine ducts (Rivinus ducts) that open at the floor of the mouth with no relation to the Wharton duct (25.0%). Of the 4 anatomic SLG duct variations, types 2 and 3 form immediate anatomic communication between the Bartholin duct and Wharton duct (39.2%). Several conclusions can be made from the present anatomic findings. 1) A certain proportion of Bartholin ducts open into the Wharton duct, and "recurrent ranula" after removal of the SLG can result from iatrogenic saliva leakage from the SMG through the surgically severed Bartholin duct if the aspirated fluid from the "recurrent cyst" is a thin seriflux. 2) The Bartholin duct emptying into the Wharton duct should be ligated during removal of the SLG to prevent local saliva accumulation from the SMG or even caudal "recurrence" as plunging ranula. 3) The surgical incision for SLG removal should be sutured loosely so that the surgically severed Bartholin duct with communication to the Wharton duct can reopen at the floor of mouth as an outlet for possible saliva leakage from the SMG and saliva accumulation can be avoided.

A Very Rare Case of Adenocarcinoma of Bartholin's Gland

Abstract Background: Among vulvar neoplasms, 0.1%–5% originate from a Bartholin's gland. Primary adenocarcinoma of a Bartholin's gland is very rare. To date, only ∼65 cases have been reported in the world literature. This article describes a rare case of a Bartholin's gland adenocarcinoma and its management. Case: A 45-year-old female, para 7, 7 living, who was tubectomized 10 years prior to presentation complained of having a mass in her vagina for 1 year. On examination, a 5×5–cms hard but tender swelling, in the region of the left Bartholin's gland, free from the pubic ramus, was felt. No obvious ulceration was seen. Her vaginal mucosa was intact. On rectal examination, the mucosa and parametria were noted to be free. Based on these findings, a clinical diagnosis of Bartholin's duct or gland malignancy was made. A transperineal ultrasound-guided scan showed a 4.4×5.3×4 cm well-defined hypoechoic focal lesion in the entire vagina extending up to the external surface of the vulva. A computed tomography s...

Chlamydia Infections in Children and Adolescents

1. Lorena M. Siqueira, MD, MSPH* 1. *Division of Adolescent Medicine, Miami Children’s Hospital, Miami, FL. * Abbreviations: CDC: : Centers for Disease Control and Prevention FDA: : Food and Drug Administration HIV: : human immunodeficiency virus LGV: : lymphogranuloma venereum MIF: : microimmunofluorescent MSM: : men who have sex with men NAAT: : nucleic acid amplification tests PID: : pelvic inflammatory disease STI: : sexually transmitted infection 1. The need for annual screening for chlamydia in sexually active adolescents and young adults is underrecognized because this infection is asymptomatic in most females (75%) and males (50%). 2. Difficulty in diagnosis arises from the range of possible symptoms at presentation of symptomatic infections and the type of testing that can be used in each situation. After completing this article the reader should be able to: 1. Recognize the spectrum of clinical manifestations of chlamydia infection in neonates, children, and adolescents. 2. Discuss the appropriate use of culture and nonculture diagnostic tests for chlamydia infections in various age groups. 3. List the current recommendations for screening and treatment of chlamydia infections. A 17-year-old girl presents with prolonged menstrual bleeding associated with severe menstrual cramping pain. Her menarche was at age 13 years. Subsequent menstrual cycles were monthly, lasting 5 days, with average flow associated with mild to moderate pain relieved by over-the-counter pain medications. The current cycle began a month ago and is associated with severe lower abdominal pain. She admits to sexual activity with one partner and uses condoms intermittently. On examination she is afebrile and in discomfort, with a heart rate of 120 beats per minute. She does not appear anemic and has good capillary refill. She has diffuse abdominal pain with significant tenderness in both the right lower and upper quadrants. Chlamydiae are small obligate, gram-negative, intracellular bacteria that contain both DNA and RNA and were formerly considered to be viruses. There are 3 species that are pathogenic to humans: Chlamydia trachomatis , Chlamydophilia pneumoniae, and Chlamydophilia psittaci . They fall within 2 genera in the family Chlamydiaceae . C trachomatis is in …

Smooth Muscle Neoplasms of the Vulva Masquerading as Bartholin Gland Duct Cysts

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.

Ductal variation of the sublingual gland: A predisposing factor for ranula formation

The purpose of this study was to evaluate ranula development according to anatomic variation of the sublingual gland (SLG). We conducted a prospective, consecutive case series considering other clinical conditions. Twenty-five cases treated by SLG excision were enrolled in this study. The ductal structures of the SLGs of another 11 patients undergoing similar surgeries for other conditions were compared. In 19 of a total of 25 ranulas (76.0%) and 16 of 18 oral nonplunging ranulas (88.9%), the SLG showed an anatomic variation of the main duct called Bartholin's duct structure. Meanwhile, only 3 of 7 plunging ranulas (42.9%) had Bartholin's ducts. Bartholin's duct structure of the SLG was not found in the 11 control cases. Anatomic variation of the ductal system of the SLG might be a possible cause of ranulas. Surgical resection of the SLG is a better treatment choice for ranulas than other, more conservative treatments.