Arch Gynecol Obstet (2008) 277:255–256 DOI 10.1007/s00404-007-0458-6 123 CASE REPORT Vulvar endometriosis in surgical scar after excision of the Bartholin gland: report of a case Alessandro Buda · Luisa Ferrari · Chiara Marra · Paolo Passoni · Patrizia Perego · Rodolfo Milani Received: 11 April 2007 / Accepted: 27 August 2007 / Published online: 12 September 2007  Springer-Verlag 2007 Abstract Endometriosis is a common gynecologic dis- ease characterized by growth of endometrial glands and stroma outside the endometrium. Implants are most com- monly found in the pelvis but can occur in many other sites. Vulvar involvement of endometriosis is extremely rare. A case of vulvar endometriosis is presented. Endometriosis was inWltrating the subcutaneous scar tissue of left labia minora after cystectomy of Bartholin gland for abscess that has recurred several times despite oYce-based treatment. Keywords Vulvar endometriosis · Surgical scar · Bartholin gland excision Case report A 39-year-old woman, gravida 2 para 2, has been experi- encing vulvar enlarging mass of the left labia minora over a period of 5 months. She had a normal menstrual cycle with no history, or symptoms to suggest the presence of endo- metriosis. Clinical suspicious of vulvar endometriosis arises from the periodic swelling of the mass appeared more prominent during menses. Patient had previously undergone 6 years before a left cystectomy for Bartholin gland abscess recurred several times despite oYce-based treatment in another institution. Vulvar hematoma on the operation site occurred, but resolved without any further surgical treatment. Moreover, 7 months before she underwent an operative laparoscopy with right salpingo-oophorectomy due to large benign serous ovarian cyst. Endometrial biopsy was also performed in a routine fashion due to appearance of metror- rhagia over last three months. Intraoperative Wndings were unremarkable and there were no or suspicious of pelvic endometriosis, also at the Wnal pathologic studies of the ovary. Histological Wndings on endometrial specimen were normal. On examination the mass presented nodular and Wrm, with irregular proWle; it was 2 cm in length and 1.5 cm in width arising from subcutaneous tissue under the scar of previous surgery in the left labia minora on the posterolat- eral aspect of the vestibule. Uterus and left ovary were nor- mally both at pelvic and ultrasonographic examination. Far-oV the menstrual cycle a wide excision of the mass together with the scar tissue was performed under spinal anesthesia. During operation ruptured of a small cyst dem- onstrated a chocolate-colored poured into operation Weld. The histopathologic examination conWrmed the presence of endometrial tissue. Endometrial glands appearing through- out the Wbro-fatty tissue presented irregular arrangement with stroma. Associated areas of Wbrosis as well as small aggregated of hemosiderin were also commonly observed (Figs. 1, 2). Three months after operation, the patient is symptom- free with no signs of recurrence. Discussion Endometriosis is one of the most benign condition that often causes pain and infertility. Endometriosis is found A. Buda (&) · L. Ferrari · C. Marra · P. Passoni · R. Milani Department of Obstetrics and Gynecology, University of Milano-Bicocca, Bassini Hospital, Cinisello Balsamo, Milan, Italy e-mail: alessandro.buda@fastwebnet.it P. Perego Department of Pathology, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy