Obstetrics & Gynecology>>>>>Benign and Malignant Disorders of the Breast and Pelvis
Question 3#

A 68-year-old woman is seen for evaluation of a swelling in the right, posterior aspect of her vaginal opening. She has noted pain in this area when walking and during intercourse. At the time of pelvic examination, a mildly tender, firm mass is noted just outside the introitus in the right vulva at approximately 8 o’clock.

Which of the following is the most appropriate treatment?

a. Marsupialization
b. Administration of antibiotics
c. Surgical excision
d. Incision and drainage
e. Observation

Correct Answer is C

Comment:

Although rare, adenocarcinoma of the Bartholin gland must be excluded in women older than 40 years of age who present with a cystic or solid mass in this area. The incidence peaks in women in their sixties. The appropriate treatment in these cases is surgical excision of the Bartholin gland to allow for a careful pathologic examination. In cases of abscess formation, both marsupialization of the sac and incision with drainage as well as appropriate antibiotics are accepted modes of therapy. In the case of the asymptomatic Bartholin cyst, no treatment is necessary.