Urethral Caruncle

Urethral caruncles are not uncommon in postmenopausal women, but their bright red fleshy appearance may occasionally raise the concern for a carcinoma (Fig. 41).

Figure 37 Bartholin's carcinoma. (A) Note swelling in the region of the left Bartholin's gland. (B) These lesions may be squamous, transitional, or adenocarcinoma as shown here.

Female Urethral Caruncle

Figure 37 Bartholin's carcinoma. (A) Note swelling in the region of the left Bartholin's gland. (B) These lesions may be squamous, transitional, or adenocarcinoma as shown here.

Table 37 Bartholin's Gland Carcinoma

Clinical

Differential

Diagnosis

Symptoms

appearance

diagnosis

Therapy

Bartholin's

Painless mass,

Mass in

Bartholin's

Surgery, usually modified

gland

itching,

region of

cyst or

radical vulvectomy, and

carcinoma

bleeding

Bartholin's

abscess

lymphadenectomy. Adjuvant

gland

radiation may be utilized,

and rarely chemotherapy

Caruncles, which probably represent ectropion of the distal posterior urethra (76), may be related to the hypoestrogenic milieu of menopause. They appear as red polypoid protrusions from the urethra. Histologically, the diagnosis is usually clear cut. The lesion has a polypoid or papillary configuration and is lined by sometimes hyperplastic squamous or transitional cells. There are abundant vessels and inflammatory cells in the stroma, with an appearance of granulation tissue; however, Young et al. (77) have described an unusual variant containing atypical stromal cells mimicking a lymphoma or sarcoma (Table 41).

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