[1129] The Pathologic Spectrum of Clinically Cystic Vulvar Lesions: A Single-Institutional, 10-Year Experience with 83 Cases

Oluwole Fadare, Vinita Parkash. Vanderbilt University, Nashville; Yale University, New Haven

Background: Vulvar cysts are known to be uncommon, but a systematic analysis of their full clinicopathologic spectrum as seen in a routine pathology practice is lacking. To facilitate patient counselling in patients presenting with a vulvar cyst, we conducted a study designed to define 1) the spectrum, frequency and proportional distribution of pathologic entities that are seen in patients presenting with a vulvar cyst, and 2) the proportion of those cases that are malignant neoplasms.
Design: An institutional database was queried for all vulvar cases that were designated as cystic in the clinical history or specimen description sections in a 10-year period (2001-2011). All cases (n=83, table 1) were reviewed and classified by gynecologic pathologists.
Results: The average patient age was 46.3 years and the mean aggregate size of submitted tissues was 2.05 cm. The most common cysts were follicular cysts (39.75%) and Bartholin cysts (22.9%). Only 3 cases were malignant (squamous cell carcinomas, SCC), but all 3 cases were recurrences in patients with known vulvar SCC. Specific clinical impressions were stated in 40 cases, and this matched the final pathologic diagnoses in 28. For the groups with ≥3 cases, the highest clinical/pathologic concordance rates were in Bartholin cysts and SCC (100%) whereas the lowest was in pseudocysts, granulation tissue and abscesses (25%). 7% (6/83) of these clinically cystic lesions were entirely solid pathologically.

Distribution of entities presenting as a vulvar cyst (n=83)
LesionNumber of casesPatient age (mean)Average sizeClinical-Pathologic Concordance rate (%)
Follicular (Epidermoid) cyst3350.61.560
Bartholin cyst1942.82.9100
Abscess, pseudocyst or granulation tissue839.21.825
Mucinous cyst437.70.950
Hidradenoma papilliferum3492X
SCC3682.6100
Mullerian cyst2402.10
Fibroepithelial polyp239.50.6X
Lipoma2454.7X
Angioleiomyoma1454.50
Benign Phyllodes tumor1672X
Myofibroblastoma1452.2X
Hemangioma235.51.40
Periurethral (Skene gland) cyst1311.5100
Lymphangioma1374.5100
X clinical impressions not stated


Conclusions: Clinically cystic vulvar lesions encompass a wide spectrum of pathologic lesions, data on which are outlined, which may be useful in the counselling of patients presenting with a vulvar cyst. Vulvar cysts are only rarely malignant (3.6%), and such lesions are typically recurrences of known malignancies. In this series, there were no patients without a history of malignant vulvar neoplasia presenting with a vulvar cyst that ultimately proved to be malignant.
Category: Gynecologic & Obstetrics

Wednesday, March 21, 2012 1:00 PM

Poster Session VI # 180, Wednesday Afternoon

 

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