Paraurethral Skenes Duct Cyst

Skene's duct cysts are uncommon benign cysts that occasionally occur in the para-urethral region in infants as well as adults (Fig. 43). Cysts may arise from Skene's ducts or some of the smaller periurethral glands. Skene's glands are analogous to the male prostate, and the glands may contribute to lubrication during sexual arousal. Skene's duct cysts are lined by transitional epithelium (80). A variety of cysts in this region may be lined by squamous, transitional, or a mixture of epithelia (81). Acquired squamous inclusion cysts, after trauma such as childbirth, as well as Mullerian and Wolffian (mesonephric, or Gartner's) cysts may also arise in a paraurethral location (82). It is important for periurethral cystic lesions to be appropriately worked up, to avoid inadvertently encountering an ectopic ureterocele. Rare solid benign and malignant neoplasms may also be encountered in the periurethral

Figure 39 Metastatic renal cell carcinoma to vulva: there is nothing distinctive in the gross appearance to distinguish whether this is a primary or metastatic lesion, and histology and clinical history are important.
Table 39 Metastatic Malignancy to the Vulva

Clinical

Differential

Diagnosis

Symptoms

appearance

diagnosis

Therapy

Metastatic

Mass, nodule, Similar to a

Primary vulvar carcinoma.

Directed at

malignancy

plaque,

primary

Metastatic breast carcinoma

primary

to vulva

ulcer

neoplasm

must be distinguished from a

tumor.

mass or

primary carcinoma arising in

Excision may

ulcer

breast-like tissue of vulva

be utilized

Table 40

Urethral Prolapse

Clinical

Diagnosis

Symptoms appearance

Differential diagnosis

Therapy

Urethral

Bleeding Periurethral

Urethral caruncle or

Medical measures

prolapse

mass

carcinoma in older

including reduction,

patients. Prolapsed

topical estrogen,

ureterocele,

particularly in

condyloma

children. Surgery for

(acumination)

refractory cases.

rhabdomyosarcoma

Surgery more usual

in children (75)

in older patients

Figure 40 Urethral prolapse: images from reduction of a urethral prolapse in a child. Source: Courtesy of Natalie Roche, MD, UMDNJ-New Jersey Medical School, Newark, New Jersey, U.S.A.

Figure 41 Urethral caruncle: a fleshy red caruncle is seen protruding through the urethral orifice. In addition, clitoromegaly and a pessary are also seen.

region, including leiomyomas and vaginal neoplasms (73). Skene's gland adenocarcinoma resembling a prostatic carcinoma has been described (Table 43) (83).

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