International Journal of Clinical & Medical Images

Clinical Image

Observation

A 35-years-old woman with no significant past medical history consults for vulvar swelling and cyclical pain. The perineum examination revealed a nodular lesion located in the site of the right-side Bartholin gland. A pelvic MRI was performed, showing a unilocular cystic lesion in the right side Bartholin gland with T2 shading, bright T1 signal, and a regular wall enhancing on post-contrast sequences. These features were consistent with the endometrioma of the Bartholin gland. Deep pelvic endometriosis was also found.

Comment

Bartholin glands are symmetrically located at the posterior section of labia minora. They play a role in vaginal lubrification. When small ducts are obstructed due to mucus accumulation it leads to cyst formation. Perineal or vulvar lesions of endometriosis are usually associated with a previous episiotomy. Bartholin gland endometriosis without prior surgery is a rare presentation of extraperitoneal endometriosis. Cyclic pain and swelling during menstruation is the typical clinical presentation [1]. Laparoscopy and histopathology are the gold standards for diagnosis. However, imaging plays an important role in preoperative disease mapping. The MRI standard protocol used is T2W, T1W, and T1W fat saturation sequence. This last sequence help in the differentiation between hemorrhagic and lipid components of the lesions. The injection of Gadolinium is recommended if malignant lesions are suspected (enhancing mural nodules). Endometrioma features are a cystic mass with high signal intensity on T1- weighted images and low signal intensity on T2- weighted images. The cause of this is repeated hemorrhage which results in high protein and iron concentration which is called

Keywords: Endometriosis; Perineal endometrioma; Bartholin cyst