Koenig C, Tavassoli F A
Department of Gynecologic and Breast Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA.
Int J Gynecol Pathol. 1998 Oct;17(4):289-94. doi: 10.1097/00004347-199810000-00001.
Inflammatory lesions and cysts are by far the most common causes of swelling or enlargement of Bartholin's glands, and carcinomas, though rare, are the most frequent solid lesions that arise at this site. There have been very few reports of benign solid lesions of Bartholin's gland, and, among these lesions, the distinction between adenoma (AD) and hyperplasia has not been well defined. All cases diagnosed as either Bartholin's gland adenoma or hyperplasia in the Armed Forces Institute of Pathology files were reviewed. Using specific criteria, 17 qualified as nodular hyperplasia (NH), 1 as AD, and 1 as adenomyoma (AM). Five NHs, the AD, and the AM were studied with immunohistochemical stains for estrogen receptor (ER), progesterone receptor (PR), MIB-1, and p53. The average age of the patients with NH was 35 years (range, 19 to 56). These lesions were solid or solid and cystic, had a mean maximal dimension of 2.3 cm, and were frequently thought to be Bartholin's cysts on clinical examination. Microscopically, the NHs had an irregular or lobulated contour and were composed of a proliferation of cytologically bland mucinous acini with maintenance of the normal duct-to-acinar relationship. Varying degrees of inflammation and squamous metaplasia of the ducts were common in NH. The patient with the AD was 45 years old and the patient with AM was 65. Both were well-circumscribed, solid lesions, 2.2 and 2.5 cm in maximal dimension, respectively, and composed of a haphazard proliferation of acini and tubules. A small adenoid cystic carcinoma (ACC) arose from the periphery of the AD. p53 positivity was evident in up to 40% of the ACC cells; the cells in the adjacent AD were negative for p53. Only occasional cells were MIB-1 positive (< 5%) in some cases, and ER and PR were absent in the epithelial elements in all 7 cases tested but were focally present in the stromal cells of 3 of the 5 NHs and the fibromuscular stroma of the AM. The patient with the AM and the one with the AD are alive without evidence of recurrent or metastatic disease after 4 months and 19.8 years, respectively. NH, AD, and AM of the Bartholin's gland, as defined in this study, are extremely rare lesions. NH occurs in younger patients and is often associated with inflammation or obstruction of Bartholin's duct.
炎症性病变和囊肿是巴氏腺肿胀或增大最常见的原因，而癌虽然罕见，但却是该部位最常见的实性病变。关于巴氏腺良性实性病变的报道极少，在这些病变中，腺瘤（AD）和增生之间的区别尚未明确界定。对武装部队病理研究所档案中所有诊断为巴氏腺腺瘤或增生的病例进行了回顾。根据特定标准，17例符合结节性增生（NH），1例为AD，1例为腺肌瘤（AM）。对5例NH、1例AD和1例AM进行了雌激素受体（ER）、孕激素受体（PR）、MIB-1和p53的免疫组化染色研究。NH患者的平均年龄为35岁（范围19至56岁）。这些病变为实性或实性与囊性混合，平均最大直径为2.3 cm，在临床检查中常被认为是巴氏腺囊肿。显微镜下，NH的轮廓不规则或呈分叶状，由细胞学上温和的黏液性腺泡增生组成，保持正常的导管与腺泡关系。NH中导管不同程度的炎症和鳞状化生很常见。AD患者45岁，AM患者65岁。两者均为边界清晰的实性病变，最大直径分别为2.2 cm和2.5 cm，由腺泡和小管的杂乱增生组成。一个小的腺样囊性癌（ACC）起源于AD的周边。高达40%的ACC细胞中p53呈阳性；相邻AD中的细胞p53为阴性。在某些病例中，仅偶尔有细胞MIB-1呈阳性（<5%），在所有检测的7例病例中，上皮成分中ER和PR均缺失，但在5例NH中的3例的基质细胞和AM的纤维肌性基质中局灶性存在。AM患者和AD患者分别在4个月和19.8年后存活，无复发或转移疾病的证据。本研究中定义的巴氏腺NH、AD和AM是极其罕见的病变。NH发生于较年轻患者，常与巴氏腺导管炎症或阻塞有关。
