Large-volume mucinous cyst of the Bartholin's gland

Specialty: Gynecology and breast.

• Giant bartholinocele
• asymptomatic giant vestibular cyst
• cystic distention of the Bartholin's gland

Why it occurs

• Long-term obstruction of the main duct of the Bartholin's gland with massive and progressive accumulation of mucus and high-density sterile lubricating secretion, which expands the tissue of the vulvar labia majora to reach diameters greater than 5-8 cm without active bacterial infection.

Initial workup

Perineal examination (a lobulated, soft, fluctuating mass is observed, not painful on pressure, which displaces the posterior vulvar commissure contralaterally). High-resolution vulvar ultrasound to certify pure mucinous cystic content (absence of dense internal echoes or vascularized septa). Cytological examination or biopsy of the cystic wall in women over 40 years of age during the surgical procedure.

Standard management

• There are no drugs indicated to dissolve or reduce the size of established large-volume mucinous cysts. The treatment of choice consists of surgical marsupialization of the cyst under general anesthesia or sedation (it consists of opening the wall of the cyst and suturing its edges to the vaginal mucosa to create a new permanent drainage hole for the mucous secretion). In cases of large recurrent cysts that seriously alter the vulvar anatomy, complete surgical excision of the gland (bartholinectomy) is indicated, a procedure that requires exhaustive control of hemostasis due to the high risk of hematomas in the perineal vascular bed (note: avoid simple puncture aspiration as it constantly recurs).