Benign Tumors of the Vulva & Vagina

Teratomas, hemangiomas, simple cysts of the hymen, retention cysts of the paraurethral ducts, benign
granulomas of the perineum, and condylomata acuminata are some of the benign vulvar neoplasms
observed in children and adolescents.
Obstruction of a paraurethral duct may form a relatively large cyst that distorts the urethral orifice. The
recommended treatment is incision and drainage, marsupialization, or excision.
Teratomas usually present as cystic masses arising from the midline of the perineum. Although a
Teratomas in this area may be benign, local recurrence is likely. To prevent recurrences, a generous
margin of healthy tissue is excised about the periphery of the mass.
Capillary hemangiomas usually disappear as the child grows older and thus require no therapy except
reassurance. Cavernous hemangiomas, in contrast, are composed of vessels of considerable size, and
injury to them may cause serious hemorrhage. They are best treated surgically.
Most benign tumors of the vagina in children are unilocular cystic remnants of the mesonephric duct.
Small cysts of the mesonephric duct (Gartner's duct) do not require surgery when they are
asymptomatic. Large cysts must be treated surgically. The technical difficulties associated with excision
of a large mesonephric cyst from the wall of the vagina in an infant may be considerable. Removal of a
large portion of the cyst wall and marsupialization of the edges, which prevents reaccumulation of fluid,
usually are sufficient.
Many incidences are recorded that vaginal tumors are misdiagnosed as simple vaginal cysts, and some
vaginal cysts may undergo proliferation and change into cancerous lesions. One of the examples of that
is Bartholin cysts.
Carcinoma of Bartholin's Gland:
After menopause, Bartholin gland duct cysts and abscesses are uncommon and should raise suspicion of
neoplasia. Carcinoma of the Bartholin gland is rare, it accounts for 1% of vulvar cancers, and its
incidence approximates 0.1 per 100,000 women. A majority of lesions are squamous carcinomas or
adenocarcinomas. Given the rarity of these cancers, Bartholin gland excision is typically not indicated.
Alternatively, in women older than 40 years, drainage of the cyst and biopsy of suspicious cyst wall sites
adequately excludes malignancy. Because it may be difficult to differentiate by clinical examination a
tumor of Bartholin's gland or duct from a benign Bartholin's cyst, any woman older than age 40 years
should undergo a biopsy to rule out cancer, as an inflammatory disease is not common in this age group.
Because of its location deep in the substance of the labium, a tumor may impinge on the rectum and
directly spread into the ischiorectal fossa. Consequently, these tumors have access to lymphatic
channels draining directly to the deep pelvic lymph nodes as well as to the superficial channels draining  to the inguinal lymph node.