[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)

Lesion	Number of cases	Patient age (mean)	Average size	Clinical-Pathologic Concordance rate (%)
Follicular (Epidermoid) cyst	33	50.6	1.5	60
Bartholin cyst	19	42.8	2.9	100
Abscess, pseudocyst or granulation tissue	8	39.2	1.8	25
Mucinous cyst	4	37.7	0.95	0
Hidradenoma papilliferum	3	49	2	X
SCC	3	68	2.6	100
Mullerian cyst	2	40	2.1	0
Fibroepithelial polyp	2	39.5	0.6	X
Lipoma	2	45	4.7	X
Angioleiomyoma	1	45	4.5	0
Benign Phyllodes tumor	1	67	2	X
Myofibroblastoma	1	45	2.2	X
Hemangioma	2	35.5	1.4	0
Periurethral (Skene gland) cyst	1	31	1.5	100
Lymphangioma	1	37	4.5	100

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