Resection of the inferior pubic ramus to completely remove locally advance adenoid cystic carcinoma of Bartholin's gland.

OBJECTIVE

Some sections of the pelvic bone can be removed without severe loss of function, including the inferior pubic ramus. Here we report a technique for the complete resection of locally advanced adenoid cystic carcinoma (ACC) of the Bartholin's gland that had invaded the obturator muscle and inferior pubic ramus.

METHODS

We chose to operate because there was little evidence of definitive radiotherapy for ACC of the vulva. As preoperative imaging did not suggest lymph node metastasis, we omitted lymphadenectomy. The perineal incision was made to obtain at least a 2-cm margin of the normal tissue around the tumor at the lateral side. The histologic margin was based on head and neck data as this disease presents more commonly in that part of the body. Pelvic reconstruction was performed using the gracilis myocutaneous flap, and the ileal conduit reservoir and sigmoid stoma was constructed.

RESULTS

Total pelvic excenteration with resection of the inferior ramus was performed. As the actual margin distance was >2cm, postoperative radiotherapy was not needed. As a part of her surveillance regimen, MRI was performed every 6months and CT of the chest was performed annually. One year postoperatively, she is alive with no evidence of disease. During the last follow-up, she did not have any major complications in daily life. If anything, she cannot run.

CONCLUSIONS

Understanding that the inferior pubic ramus can be resected without severe functional loss will increase treatment choice. We achieved complete resection of locally advanced ACC of the Bartholin's gland.