Case Report: Bartholin's gland leiomyoma masquerading as a bartholin's cyst: a rare clinical entity and diagnostic challenges.

BACKGROUND

Leiomyomas are benign smooth muscle tumors that most commonly arise in the uterus but may occasionally occur in extra-uterine locations, including the vulva. Vulvar leiomyomas, especially those originating from the Bartholin gland, are uncommon and often misdiagnosed as Bartholin's cysts or abscesses, leading to diagnostic challenges.

CASE PRESENTATION: We report the case of a 44-year-old female with a longstanding, slowly enlarging right vulvar mass initially presumed to be a Bartholin's cyst. The patient had no significant past medical history, no allergies, no family history of malignancy, and a BMI of 24. On examination, a firm, non-fluctuant 4 × 4 cm mass was palpated in the right Bartholin's gland region. Surgical excision was performed under general anesthesia. Histopathological evaluation revealed a well-circumscribed spindle-cell tumor with desmin positivity, confirming a benign leiomyoma. There was no evidence of necrosis, atypia, or malignancy.

DISCUSSION: Vulvar leiomyomas are uncommon and can arise from smooth muscle elements such as blood vessels, the round ligament, erector pili muscles, or Bartholin's gland erectile tissue. Clinically, they present as painless, slow-growing masses and are frequently misdiagnosed preoperatively. Definitive diagnosis requires histopathology and immunohistochemistry to differentiate from leiomyosarcoma and other vulvar masses. Complete surgical excision with clear margins is the treatment of choice, with a low risk of recurrence.

CONCLUSION

Bartholin's gland leiomyomas are uncommon benign tumors that may mimic more frequent vulvar lesions. Accurate recognition, histopathologic confirmation, and complete excision are essential for optimal management and favorable outcomes. Increased awareness of this uncommon entity can reduce misdiagnosis and improve patient care.