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.
|Lesion||Number of cases||Patient age (mean)||Average size||Clinical-Pathologic Concordance rate (%)|
|Follicular (Epidermoid) cyst||33||50.6||1.5||60|
|Abscess, pseudocyst or granulation tissue||8||39.2||1.8||25|
|Benign Phyllodes tumor||1||67||2||X|
|Periurethral (Skene gland) cyst||1||31||1.5||100|