Bartholin gland cyst/abscess, VIN

Question 1

What is another name for bartholin gland?

Answer 1

Greater vestibular glands

Question 2

Where are the bartholin glands located?

Answer 2

Vulvar vestibule bilaterally

Question 3

What causes a bartholin cyst or abscess?

Answer 3

Blockage of the bartholin duct leading to accumulation of duct fluid behind the blockage

Question 4

What is the function of the bartholin gland?

Answer 4

Secreting mucus to keep vagina lubricated

Question 5

What bacteria can lead to infection of the bartholin duct?

Answer 5

Most commonly E.coli but could be an STI as well

Question 6

If there is an abscess and pus is obtained via spontaneous drainage or I&D what test should you do?

Answer 6

Send culture for fluid
STI testing if at risk for sexually transmitted infection

Question 7

What patient require a vulvar biopsy for bartholin cyst/abscess?

Answer 7

Postmenopausal
Suspicious for malignancy
Not responding to treatment

Question 8

What is the management for small bartholin cysts <3cm?

Answer 8

Expectant management. Recommend warm compresses and sitz baths for symptomatic small cysts

Question 9

What is the management for large bartholin cysts >3cm?

Answer 9

I&D and word catheter placement
If latex allergy then marsupilization

Question 10

What is the management for a small bartholin abscess <3cm?

Answer 10

I&D

Question 11

What is the management for a large bartholin abscess >3cm?

Answer 11

I&D with word catheter placement

Question 12

When is antibiotics indicated for management of bartholin cyst or abscess?

Answer 12

Large mass + MRSA positive culture, risk for MRSA, immunocompromised, recurrent mass, extensive surrounding cellulitis, pregnancy, signs of systemic infection

Question 13

When is IV antibiotics indicated for management of bartholin cyst or abscess?

Answer 13

Signs of systemic or progressive infection or unable to tolerate oral antibiotics

Question 14

What bacteria do you want to cover when treating a bartholin cyst/abscess with antibiotics?

Answer 14

Staph
Strep
E.coli

Question 15

What oral antibiotic do you use to treat a large bartholin mass concerning for systemic illness/infection?

Answer 15

Bactrim

or

Doxy+ flagyl

Question 16

What IV antibiotic do you use to treat a large bartholin mass with systemic infection?

Answer 16

Vancomycin + pip tazo

Question 17

What is VIN?

Answer 17

Vulvar intraepithelial neoplasia
Premalignant lesion

Question 18

What is VIN usual type?

Answer 18

Vulvar HSIL

Question 19

What is VIN differentiated type?

Answer 19

Vulvar dermatological conditions

Question 20

How can you reduce risk of VIN usual type?

Answer 20

HPV vaccine

Question 21

What is the management of vulvar HSIL/VIN usual type?

Answer 21

1. Excision
2. Laser abltion
3. Topical imiquimoid

Question 22

What is the management for Vulvar squamous cell cancer or suspected cancer?

Answer 22

Wide local excision

Question 23

What is the follow up after treatment for Vulvar HSIL/VIN usual type?

Answer 23

6 months, 12 months then annually

Question 24

When is biopsy indicated for vulvar lesion?

Answer 24

1. Uncertain diagnosis
2. Stable mass that changes in color, size or borders
3. Mass not responsive to treatment
4. Mass suspicious for malignancy
5. Mass with atypical vascular patterns

Question 25

Which type of VIN is more likely to be associated with a vulvar squamous cell carcinoma?

Answer 25

VIN differentiated type

Question 26

When is wide local excision recommended with vulvar disease?

Answer 26

When there is a biopsy diagnosis of VIN HSIL but invasive cancer cannot be ruled out

Question 27

What margins do you want on a wide local incision?

Answer 27

0.5-1cm around diseased tissue

Question 28

How do you use imiquimoid for VIN HSIL?

Answer 28

5% imiquimoid therapy 3x per week for 12-20 weeks with colposcopy every 4-6 weeks to assess progress