Previous literature has described instances of pathology occurring concurrently with Bartholin's abscess or cyst. Literature describes a case of cellular angiofibroma for which the preoperative diagnosis was Bartholin's glandular cyst . Another case report described a vulvar mass that was preoperatively diagnosed as a Bartholin's duct cyst but found to be leiomyosarcoma, a rare gynecologic malignancy . Although significant clinical correlations between hidradenoma papilliferum and Bartholin's abscess are not well understood at this point, the intimate association between these two lesions seen on histological examination suggests partial or complete obstruction of ductal drainage by the tumor mass. Thus, indicating Bartholin's abscess arising due to the presence of hidradenoma papilliferum.
Bartholin's glands are bilaterally located at the base of the labia minora and drain through 2- to 2.5-cm-long ducts that empty into the vestibule at the 4 o'clock and 8 o'clock positions [5, 6]. Hidradenoma papilliferum usually presents as a slow-growing, small (2 mm to 3 cm) nodule which most commonly arise from the apocrine sweat glands between the labia majora and labia minora . Woodworth et al. reported 38% of hidradenoma papilliferum originate from the labia majora and 26% originate from the labia minora . Occurrence of hidradenoma papilliferum in the labia minora certainly presents the possibility of disrupting or blocking the ducts of Bartholin's glands which are located within the vicinity.
Due to hidradenoma papilliferum's mixed eccrine and apocrine features, cyst or abscess formation secondary to the disruption of ductal drainage should be considered . Hidradenoma papilliferum should be present in the differential in the context of recurrent cysts/abscesses in the anogenital region . The clinical differential diagnosis of a Bartholin's abscess, which includes mucous cysts, epidermal inclusion cysts, and hidradenoma papilliferum , demonstrates the importance of maintaining an awareness of differentiation between Bartholin's abscess and hidradenoma papilliferum.
Diagnostically, hidradenoma papilliferum tends to occur exclusively in post-pubescent white women between the ages of 30 and 70, occurring most commonly in the fourth decade [8, 9]. Interestingly, our diagnosis of Bartholin's abscess arising in hidradenoma papilliferum was made in an African American woman.
Though it has been suggested surgical excision of Bartholin's abscess is unnecessary due to the low risk of Bartholin's gland cancer , our finding of hidradenoma papilliferum and other mentioned neoplasms demonstrates the need for an increased level of suspicion with a preoperative diagnosis of Bartholin's abscess. Gynecologic oncology referral is also supported in patients older than 40 years of age with a Bartholin's abscess to rule out adenocarcinoma .
While hidradenoma papilliferum is a benign tumor, malignant transformations to adenocarcinoma or adenosquamous carcinoma have been reported, although rare [12–16]. Therefore, a diagnosis of Bartholin's abscess without further investigation into the presence of hidradenoma papilliferum may put the patient as risk for a malignant process.