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Clinical implications of the forgotten Skene's glands: A review of current literature

Authors:

Abstract

Introduction: The clinical and pathological aspects of the Skene's glands have not been addressed in the current scientific literature. Aim: To review the current literature to focus on the clinical and pathological aspects of the Skene's glands. The historical perspective including embryology, anatomy, histology, and current role of prostatic specific antigen (PSA) as a tumor marker of lesions which develop from the Skene's glands, 'female prostate.'. Material and methods: Medline searches were performed to review the current literature regarding Skene's glands pathology, clinical manifestations, diagnosis, role of PSA, and its treatment options. Discussion: Anatomical pathology including inflammatory, cystic, solid, benign, and malignant tumors of Skene's glands is emphasized. The unique role of PSA in these lesions is reviewed. Cognizance of periurethral, perimeatal and urethral masses is essential for anatomical pathologists, radiologists, urologists and gynecologists who encounter complex female urethral masses in their clinical practice. Imaging techniques of Skene's glands to diagnose urethral, perimeatal and periurethral masses in female are reviewed. Conclusions: The literature of the interesting scientific concepts related to the Skene's glands are reviewed. The role of PSA in these lesions is expanded for diagnoses and treatment options of pathology of the Skene's glands. Methods of imaging are necessary for radiologist, pathologists, and clinicians alike, for the proper treatment of Skene's gland lesions.
Review
article
Clinical
implications
of
the
forgotten
Skene's
glands:
A
review
of
current
literature
Gautam
Dagur
a
,
Kelly
Warren
a
,
Reese
Imhof
a
,
Jacquelyn
Gonka
a
,
Yiji
Suh
a
,
Sardar
A.
Khan
a,b,
*
a
Department
of
Physiology
and
Biophysics,
SUNY
at
Stony
Brook,
New
York,
USA
b
Department
of
Urology,
SUNY
at
Stony
Brook,
New
York,
USA
1.
Introduction
In
1880,
Alexander
Skene
discovered
prostatic
glandular
tissue
proximally
located
next
to
two
large
ducts
adjacent
to
the
female
urethra,
thus
proving
the
existence
of
the
female
prostate.
1
Before
Skene's
discovery,
several
researchers
speculated
the
idea
of
the
existence
of
a
female
prostate.
A
researcher
named
Galen
rst
discussed
the
idea
of
the
female
prostate,
but
he
believed
the
prostatic
tissue
was
located
closer
p
o
l
i
s
h
a
n
n
a
l
s
o
f
m
e
d
i
c
i
n
e
x
x
x
(
2
0
1
6
)
x
x
x
x
x
x
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
15
November
2015
Received
in
revised
form
5
February
2016
Accepted
10
February
2016
Available
online
xxx
Keywords:
Dysuria
Female
prostate
Prostate
specic
antigen
Skene's
glands
Urethral
masses
a
b
s
t
r
a
c
t
Introduction:
The
clinical
and
pathological
aspects
of
the
Skene's
glands
have
not
been
addressed
in
the
current
scientic
literature.
Aim:
To
review
the
current
literature
to
focus
on
the
clinical
and
pathological
aspects
of
the
Skene's
glands.
The
historical
perspective
including
embryology,
anatomy,
histology,
and
current
role
of
prostatic
specic
antigen
(PSA)
as
a
tumor
marker
of
lesions
which
develop
from
the
Skene's
glands,
'female
prostate.'
Material
and
methods:
Medline
searches
were
performed
to
review
the
current
literature
regarding
Skene's
glands
pathology,
clinical
manifestations,
diagnosis,
role
of
PSA,
and
its
treatment
options.
Discussion:
Anatomical
pathology
including
inammatory,
cystic,
solid,
benign,
and
malig-
nant
tumors
of
Skene's
glands
is
emphasized.
The
unique
role
of
PSA
in
these
lesions
is
reviewed.
Cognizance
of
periurethral,
perimeatal
and
urethral
masses
is
essential
for
anatomical
pathologists,
radiologists,
urologists
and
gynecologists
who
encounter
complex
female
urethral
masses
in
their
clinical
practice.
Imaging
techniques
of
Skene's
glands
to
diagnose
urethral,
perimeatal
and
periurethral
masses
in
female
are
reviewed.
Conclusions:
The
literature
of
the
interesting
scientic
concepts
related
to
the
Skene's
glands
are
reviewed.
The
role
of
PSA
in
these
lesions
is
expanded
for
diagnoses
and
treatment
options
of
pathology
of
the
Skene's
glands.
Methods
of
imaging
are
necessary
for
radiologist,
pathologists,
and
clinicians
alike,
for
the
proper
treatment
of
Skene's
gland
lesions.
#
2016
Warmińsko-Mazurska
Izba
Lekarska
w
Olsztynie.
Published
by
Elsevier
Sp.
z
o.o.
All
rights
reserved.
*
Correspondence
to:
HSC
Level
9
Room
040,
SUNY
at
Stony
Brook,
Stony
Brook,
NY
11794-8093,
USA.
Tel.:
+1
631
987
0132/44
7620.
E-mail
address:
skysalik@gmail.com
(S.A.
Khan).
POAMED-164;
No.
of
Pages
9
Please
cite
this
article
in
press
as:
Dagur
G,
et
al.
Clinical
implications
of
the
forgotten
Skene's
glands:
A
review
of
current
literature,
Pol
Ann
Med.
(2016),
http://dx.doi.org/10.1016/j.poamed.2016.02.007
Available
online
at
www.sciencedirect.com
ScienceDirect
journal
homepage:
http://www.elsevier.com/locate/poamed
http://dx.doi.org/10.1016/j.poamed.2016.02.007
1230-8013/#
2016
Warmińsko-Mazurska
Izba
Lekarska
w
Olsztynie.
Published
by
Elsevier
Sp.
z
o.o.
All
rights
reserved.
to
the
fallopian
tubes
than
the
urethra.
In
1672,
de
Graaf
described
ducts
in
close
proximity
to
the
female
urethral
meatus,
and
believed
that
these
structures
drained
the
female
prostate.
2
In
1853,
Virchow
described
stone-like
masses
inside
the
ducts
surrounding
the
urethral
meatus.
He
concluded
these
urethral
glands
and
ducts
were
homologous
to
the
male
prostate.
In
1889,
Tourneaux
similarly
described
glands
adjacent
to
the
urethral
meatus,
stating
that
these
glands
were
structurally
similar
to
the
prostatic
glands
of
a
ve-
to
six-month-old
male
fetus.
3
Pallin,
in
1901,
found
that
the
Skene's
glands
are
not
homologous
to
the
whole
male
prostate,
but
to
the
cranial
and
ventral
portions.
In
1922,
Johnson
examined
female
fetuses
at
different
developmental
stages
comparing
female
embryology
with
that
of
a
male.
He
noted
that
the
Skene's
glands
rst
appear
in
60-mm
female
embryo,
and
that
the
glands
were
distributed
along
the
anterior,
posterior,
and
lateral
walls
of
the
urethra.
He
also
stated
that
compared
to
their
male
counterpart,
Skene's
glands
are
'fewer
in
number,
less
closely
packed
together,
have
fewer
branches,
thicker
epithelial
walls,
smaller
lumina,
and
less
evidence
of
epithelia
with
active
secretion.'
4
In
the
1940s,
Huffman
described
Skene's
glands
as
located
primarily
along
the
distal
half
of
the
urethra.
Additionally,
he
stated
the
'female
periurethral
glands
are
homologous
with
only
that
portion
of
the
male
prostate
arising
cephalad
to
the
urogenital
sinus.'
Huffman
also
recognized
the
importance
of
the
Skene's
gland
and
diverse
pathologies
that
can
arise
from
them.
He
noticed
that
inammation
and
irritation
of
the
glands
might
result
in
cystic
enlargement.
This
could
lead
to
obstruction
and
abscess
formation
of
the
anterior
vaginal
wall
and
urethra
while
creating
urethra-vaginal
stulas.
5,6
2.
Aim
To
readdress
the
focus
to
Skene's
glands
and
recall
the
overlooked
historical
perspective,
embryology,
anatomy,
histology,
and
current
role
of
prostatic
specic
antigen
(PSA)
as
a
tumor
marker
of
lesions
which
develop
from
the
Skene's
glands
'female
prostate.'
3.
Material
and
methods
Medline
searches
were
performed
to
review
the
current
literature
regarding
skene's
glands,
pathology,
clinical
man-
ifestations,
diagnosis,
and
treatment
options.
4.
Discussion
4.1.
Embryology,
anatomy,
and
histology
of
Skene's
glands
and
their
ducts
The
Skene's
glands
and
ducts
are
normally
located
on
the
distal
third
of
the
female
urethra,
emptying
approximately
of
an
eighth
of
an
inch
from
the
outer
edge
of
the
meatus.
1
According
to
Huffman
who
performed
serial
sections
and
wax
model
reconstructions
of
the
paraurethral
glands,
no
ducts
were
found
to
be
larger
than
4
cm.
Additionally,
they
extend
aligned
along
the
urethra's
lateral,
ventral,
and
to
a
lesser
extent,
the
dorsal
side.
The
glands
themselves
are
described
as
'branched
tubular
glands,
with
straight
or
slightly
curved
branches,
which
empty
into
the
paraurethral
ducts.'
Further-
more,
the
glands
are
limited
to
the
urethra
with
no
evidence
of
vestibular
or
vaginal
mucosa
involvement.
5,6
Johnson
de-
scribed
that
Skene's
glands
are
structurally
similar
to
the
male
prostatic
glands
as
they
are
solid,
round,
directed
toward
the
bladder,
and
extend
into
the
surrounding
mesenchyme.
They
differ
because
there
are
fewer
of
them,
they
are
dispersed,
and
do
not
exhibit
active
secretions.
4
Regarding
embryological
aspects,
Johnson
described
the
appearance
of
Skene's
glands
in
a
60-mm
female
fetus,
which
originate
from
the
urogenital
sinus.
4
Histologically,
they
are
composed
of
columnar
epithe-
lium
and
contain
pale
staining
cytoplasm.
The
nucleus
is
described
as
being
a
large
rounded
structure
that
is
located
centrally
or
basally.
Furthermore,
within
the
columnar
epithelium,
the
mucous
secreting
cells
are
stained
for
mucicarmine.
5
The
lumen
of
a
Skene's
gland
is
composed
of
tall
cylindrical
secretory
cells
with
short
microvilli.
Ample
secretory
granules
and
vacuoles
are
noted,
in
addition
to
numerous
mitochondria
and
Golgi
complexes.
Dispersed
throughout
the
secretory
cells
are
basal
cells,
referred
to
as
'reserve
cells,'
which
play
a
role
in
the
regeneration
of
cells
in
the
Skene's
glands.
The
nucleoli
of
the
basal
cells
contain
dense
chromatin.
7
Zaviacic
et
al.
describes
expression
of
human
protein
1
in
the
prostatic
tissues
of
both
males
and
females.
Human
protein
1
can
be
found
in
the
secretory
cells
of
the
Skene's
glands
which
may
function
to
protect
the
urothelium
from
the
harsh
urinary
environment.
8
4.2.
Presence
of
PSA
in
Skene's
glands
and
tumors
arising
from
Skene's
glands
Like
the
male
prostate,
the
female
prostate
Skene
glands
have
been
shown
to
stain
for
PSA.
Tepper
et
al.
examined
18
female
urethras
with
paraurethral
glands
by
staining
tissues
for
antibodies
to
PSA
and
prostate-specic
acid
phosphatase
(PSAcPH).
In
total,
83%
were
positive
for
PSA
and
67%
positive
for
PSAcPH.
This
study
thus
proved
the
homology
between
the
female
paraurethral
glands
and
male
prostate.
9
It
should
be
noted
that
the
total
PSA
level
in
a
female
arises
from
the
combination
of
female
prostatic
tissues
such
as
diseased
breast
tissue.
10
Sloboda
et
al.
described
a
case
of
a
46-year-old
female
with
adenocarcinoma
of
the
paraurethral
glands
that
stained
positive
for
PSA
and
PSAcPH,
therefore
linking
it
to
male
prostatic
carcinoma.
11
Further
studies
have
produced
similar
results,
correlating
carcinoma
of
the
Skene's
gland
to
male
prostatic
carcinoma.
12
Additionally,
just
like
males,
PSA
can
be
used
as
a
reliable
tumor
marker,
as
levels
correlate
with
responsiveness
to
treatment.
10,13
Korytko
et
al.
described
a
case
of
a
71-year-old
female
diagnosed
with
a
Skene's
gland
adenocarcinoma
with
an
initial
PSA
of
54.42
ng/mL.
Treatment
consisted
of
73.8
Gy
of
intensity-modulated
radiotherapy
in
41
fractions,
after
which
her
PSA
was
0.65
ng/mL
(32
months
after
treatment).
There-
fore,
females
presenting
with
periurethral
adenocarcinomas
should
be
evaluated
to
determine
if
they
are
Skene's
glands
in
nature,
which
would
allow
PSA
levels
to
assess
for
treatment
response.
13
Dodson
et
al.
further
discuss
the
decline
in
PSA
p
o
l
i
s
h
a
n
n
a
l
s
o
f
m
e
d
i
c
i
n
e
x
x
x
(
2
0
1
6
)
x
x
x
x
x
x2
POAMED-164;
No.
of
Pages
9
Please
cite
this
article
in
press
as:
Dagur
G,
et
al.
Clinical
implications
of
the
forgotten
Skene's
glands:
A
review
of
current
literature,
Pol
Ann
Med.
(2016),
http://dx.doi.org/10.1016/j.poamed.2016.02.007
levels
in
treatment
for
urethral
adenocarcinoma.
However,
it
is
important
to
note
that
not
all
adenocarcinomas
of
the
female
urethra
are
Skene's
gland
in
origin.
Therefore,
further
histological
testing
must
be
done
to
assess
for
the
origin
of
PSA
negative
urethral
adenocarcinomas.
14
4.3.
Signicance
of
female
ectopic
prostatic
tissue
in
reproductive
system
Normally,
female
prostatic
tissue
is
located
in
the
lower
third
of
the
urethra.
However,
ectopic
prostatic
tissue
has
been
documented
to
be
located
primarily
within
the
female
reproductive
system.
Kelly
et
al.
described
what
appeared
to
be
ectopic
prostatic
tissue
in
26
women
whose
ages
ranged
from
23
to
81.
Locations
of
ectopic
tissue
included
the
cervix,
vagina,
and
vulva,
with
the
majority
being
found
in
the
cervix.
The
majority
of
these
cases
had
associated
lesions,
which
led
to
the
initial
biopsy
of
the
tissues.
However,
some
were
incidental
ndings.
Lesions
of
the
cervix
were
mainly
located
at
the
ectocervix,
while
ectopic
tissue
was
mainly
found
in
the
form
of
polyps
and
cysts
within
the
vagina.
Immunohis-
tochemistry
was
performed
on
the
samples
that
depicted
13
of
the
26
cases
positive
for
PSA
and
16
out
of
26
positive
for
PSAcPH.
It
should
be
noted
that
all
lesions
examined
in
this
study
were
benign.
15
Although
female
ectopic
prostatic
tissue
is
exceedingly
rare,
several
cases
have
been
reported
of
ectopic
tissue
in
the
cervix.
Most
were
incidental
ndings
that
were
positive
for
PSA
and
PSAcPH.
1620
However,
McCluggage
et
al.
described
six
cases
of
ectopic
prostatic
tissue,
where
only
three
out
of
six
specimens
stained
positive
for
PSA,
but
all
were
reactive
to
PSAcPH.
21
Positive
immunoreactivity
for
PSA
and
PSAcPH
has
also
been
revealed
in
tubulo-squamous
vaginal
polyps,
indicating
that
they
probably
arose
from
Skene's
glands.
These
polyps
are
generally
located
in
the
upper
portion
of
the
vagina,
most
commonly
seen
in
postmenopausal
women.
2224
Vaginal
myobroblastomas
have
also
exhibited
ectopic
prostatic
tissue.
Lorange
et
al.
described
vaginal
bleeding
within
a
case
of
a
76-year-old
female
on
tamoxifen
for
breast
cancer
treatment.
Endometrial
work-up
revealed
a
myobroblastoma
with
ectopic
prostatic
tissue,
which
was
the
rst
of
its
kind.
25
Uzoaru
et
al.
reported
two
cases
of
benign
cystic
teratoma
arising
from
ectopic
prostatic
tissue.
26
4.4.
Diagnosis
of
pathologies
associated
with
Skene's
glands
Females
presenting
with
urogynecological
symptoms
should
initially
have
a
pelvic
exam,
urine
culture,
vaginal
secretion
culture,
and
sexually
transmitted
disease
(STD)
testing.
During
physical
examination,
one
should
look
for
any
abnormalities
adjacent
to
the
urethral
meatus,
including
cysts,
abscess,
or
tumors.
If
no
abnormalities
are
noted,
one
may
perform
a
urethrocystoscopy
and
retrograde
urethrocystography
to
search
for
obstruction
or
communications
with
the
vagina,
urethra,
and
bladder.
27
Radiologic
imaging
of
masses
at
urethrovaginal
space
can
be
accomplished
by
using
3D
ultrasonography,
endovaginal
ultrasound
with
duplex
Dopp-
ler,
endoluminal
MRI,
and
CT
scan
for
precise
diagnosis.
One
study
discussed
the
use
of
3D
ultrasonography
and
color/
power
Doppler
to
diagnosis
a
Skene's
gland
cyst,
for
clear
denition
and
3D
reconstruction
of
the
cyst.
28
If
carcinoma
is
suspected,
MRI/CT
scans
may
be
performed
for
staging
including
the
anatomical
eld
of
lymphatic
drainage
of
the
Skene's
glands.
4.5.
Differential
diagnosis
of
perimeatal,
urethral,
and
periurethral
masses
of
urethrovaginal
space
Many
times
pathologies
of
the
Skene's
gland
tend
to
be
over
looked
due
to
similarities
in
clinical
pathology
and
presenta-
tions
of
masses.
Table
1
addresses
the
various
masses
that
are
found
near
the
Skene's
glands
and
Table
2
summarizes
the
clinical
pathologies
of
Skene's
glands.
4.6.
Cysts
of
Skene's
glands
Immunohistochemistry
targets
diversify
pathologies
that
arise
from
Skene's
glands.
Rare
cases
of
paraurethral
cysts
resulting
from
Skene's
gland
have
been
reported.
27,111113
Differentials
for
Skene's
gland
cyst
include
Bartholin's
duct
cyst,
epidermal
inclusion
cyst,
hidradenoma
papilliferum,
lipoma,
urethrocele,
and
urethral
diverticulum.
114117
Etiology
of
Skene's
gland
cysts
includes
mechanical
trauma,
or
obstruction
of
the
duct.
118,119
Martin
et
al.
described
four
cases
of
Skene's
gland
cyst.
The
majority
of
these
patients
complained
of
dysuria,
dyspareunia,
and
sensation
of
a
mass
in
their
urethra.
All
women
were
rst
treated
with
antibiotics,
hygienic
treatment,
and
manual
drainage
with
no
improve-
ment
in
symptoms.
Retrograde
urethrocytoscopy
was
per-
formed
to
assess
any
signs
of
stenosis
or
anatomical
defect,
such
as
a
stula.
STD
work-up
was
negative.
Surgical
removal
with
local
anesthesia
was
the
only
option.
After
removal,
all
four
patients
remained
symptom
free,
with
no
noted
compli-
cations.
27
Although
Skene's
glands
cysts
are
uncommon
in
female
adults,
they
are
even
less
commonly
found
in
children.
One
case
involves
a
neonate
with
a
pelvic
mass
that
was
noted
on
prenatal
ultrasound.
Delivery
work-up
diagnosed
the
mass
as
a
paraurethral
cyst
located
at
the
vaginal
orice
that
drained
spontaneously
with
no
complications.
111
Allouis
et
al.
also
reported
three
neonates
with
paraurethral
cysts.
In
all
three
patients,
drainage
by
needle
puncture
was
curative.
112
4.7.
Skene's
gland
abscess
Skene's
gland
abscesses
are
a
relatively
uncommon
phenom-
enon,
with
most
cases
appearing
within
the
third
or
fourth
decades
of
life.
Differentials
for
Skene's
gland
abscess
are
similar
to
those
for
a
Skene's
gland
cyst.
114
Common
clinical
manifestations
of
a
Skene's
gland
abscess
include
dysuria,
urethral
pain,
dyspareunia,
recurrent
urinary
tract
infections,
abnormal
urethral
draining,
and
problems
voiding.
The
presence
of
pus
and
point
tenderness
at
the
distal
urethra
is
common.
When
diagnosis
is
indenite,
further
work
up
involving
an
MRI,
voiding
cystourethrogram,
cystouretho-
scopy,
or
transvaginal
ultrasound
may
be
necessary.
120122
Nickels
et
al.
described
a
case
of
a
3-year-old
child
presenting
with
vulvar
pain.
Upon
examination
the
patient
discovered
an
enlarged
right
labium
majora
and
erythematous
patch
next
to
the
urethra.
The
patient
was
diagnosed
with
a
Skene's
gland
abscess,
which
was
drained
resulting
in
complete
resolution
of
p
o
l
i
s
h
a
n
n
a
l
s
o
f
m
e
d
i
c
i
n
e
x
x
x
(
2
0
1
6
)
x
x
x
x
x
x
3
POAMED-164;
No.
of
Pages
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Please
cite
this
article
in
press
as:
Dagur
G,
et
al.
Clinical
implications
of
the
forgotten
Skene's
glands:
A
review
of
current
literature,
Pol
Ann
Med.
(2016),
http://dx.doi.org/10.1016/j.poamed.2016.02.007
symptoms.
In
general,
a
Skene's
gland
abscess
is
treated
with
incision
and
drainage,
with
minimal
complications.
However,
one
case
reports
a
14-year-old
female
who
developed
a
suburethreal
diverticulum
secondary
to
Skene's
gland
abscess.
123
Another
case
describes
the
formation
of
calculi
within
a
Skene's
gland
abscess.
Cultures
of
the
abscess
grew
Ureaplasma
urealyticum,
which
contains
the
enzyme
urease
that
causes
formation
of
stones.
Treatment
of
a
Skene's
gland
Table
1
Differential
diagnosis
of
periurethral
masses.
Differential
diagnosis
Authors
Adenosquamous
cell
carcinoma
García
et
al.
29
Amelanotic
melanoma
Satyanarayan
et
al.
32
;
Yoshii
et
al.
33
Amyloidosis
Pehlivanov
et
al.
37
Angiomas
Cook
et
al.
40
;
Davis
et
al.
41
Bladder
eversion
Kalorin
et
al.
45
;
Kim
et
al.
46
Carcino-sarcoma
Mosel
et
al.
49
Condyloma
Kishimoto
et
al.
51
;
Horn
et
al.
52
Ectopic
ureter
Demir
et
al.
56
;
Ohzeki
et
al.
57
Ectopic
ureterocele
Lopez
et
al.
59
Endometriosis
Dadhwal
et
al.
62
;
Klenov
et
al.
63
Fibroepithelial
polyp
Akbarzadeh
et
al.
65
;
Mullins
et
al.
66
;
Wilkinson
et
al.
67
Fibrosarcoma
Blanco
Rabassa
et
al.
69
Gartner's
duct
cyst
Rosenfeld
et
al.
71
;
Emmons
et
al.
72
Glomus
tumor
Silver
et
al.
74
;
Banner
et
al.
75
Hemangiomas
Davis
et
al.
41
Hematoma
Mosković
et
al.
80
;
Frioux
et
al.
81
Infected
granuloma
Hoge
et
al.
83
Leiomyoma
and
leiomyosarcoma
Jordanov
et
al.
5,86
Lymphoma
of
the
urethra
Vögeli
et
al.
89
Metastatic
disease
to
the
urethra
Suzuki
et
al.
90
Nephrogenic
adenoma
Kelly
et
al.
15
Papillary
endothelial
hyperplasia
(Masson
tumor)
Nevin
et
al.
94
Parasitic
diseases
Vilela
et
al.
97
;
Kashyap
et
al.
98
Paraurethral
cysts
Fukata
et
al.
30
;
Deppisch
et
al.
31
Paraurethral
leiomyoma
Chong
et
al.
34
;
Moriya
et
al.
35
;
Di
Cello
et
al.
36
Periurethral
abscess
Babalola
et
al.
38
;
Butler
et
al.
39
Periurethral
cyst
(Skene's
duct
cyst)
Shaririaghdas
et
al.
42
;
Moralioğlu
et
al.
43
;
Durakbasa
et
al.
44
Prolapsed
ureterocele
Landi
et
al.
47
;
Goh
et
al.
48
Retention
cyst
Wollgarten
et
al.
50
Reticulosarcoma
Spampinato
et
al.
53
;
Ciulla
et
al.
54
;
Marini
et
al.
55
Rhabdomyosarcoma
of
urethra
Liu
et
al.
58
Sarcoidosis
Schol
et
al.
60
;
Allen
et
al.
61
Sarcoma
of
urethra
Kushelev
et
al.
64
Skene's
gland
calculi
secondary
to
ureaplasma
urealyticum
Gellman
et
al.
68
Slings
Forzini
et
al.
70
Transitional
carcinoma
of
the
urethra
Kasai
et
al.
73
Tubulo-squamous
vaginal
polyp
Chaturvedi
et
al.
76
;
Petrová
et
al.
77
Urethral
adenocarcinoma
Satyanarayan
et
al.
78
;
Mimura
et
al.
79
Urethral
caruncle
Chiba
et
al.
82
Urethral
cysts
Woo
et
al.
84
Urethral
diverticulum
and
its
contents
Dong
et
al.
87
;
Jadhav
et
al.
88
Urethral
polyp
Akbarzadeh
et
al.
65
Urethral
mass
from
injection
of
bulking
agents
for
incontinence
Berger
et
al.
91
;
Lai
et
al.
92
Urethral
prolapse
Lai
et
al.
92
;
Horsburgh
et
al.
93
Vaginal
wall
cysts
Molina
Escudero
et
al.
95
;
Jayaprakash
et
al.
96
Table
2
Clinical
pathology
of
Skene's
glands.
Clinical
pathology
Authors
Urethral
caruncle
Surabhi
et
al.
99
;
Conces
et
al.
100
Urethral
prolapse
Lai
et
al.
92
;
Horsburgh
et
al.
93
;
Bennett
et
al.
102
Prolapsed
ureterocele
Landi
et
al.
47
;
Goh
et
al.
48
Condyloma
Kishimoto
et
al.
51
;
Horn
et
al.
52
;
Brook
et
al.
108
Leiomyoma
Jordanov
et
al.
85,86
;
Dasan
et
al.
110
Periurethral
cysts
(Skene's
duct
cysts,
urethral
diverticulum)
Shaririaghdas
et
al.
42
;
Moralioğlu
et
al.
43
;
Durakbasa
et
al.
44
;
Parente
Hernández
et
al.
101
Vaginal
wall
cysts
Kimbrough
et
al.
103
;
Ali
et
al.
104
Bartholin's
gland
cysts
Lee
et
al.
105
;
Dragojević
et
al.
106
;
Bhide
et
al.
107
Nevus
Fitzhugh
et
al.
109
p
o
l
i
s
h
a
n
n
a
l
s
o
f
m
e
d
i
c
i
n
e
x
x
x
(
2
0
1
6
)
x
x
x
x
x
x4
POAMED-164;
No.
of
Pages
9
Please
cite
this
article
in
press
as:
Dagur
G,
et
al.
Clinical
implications
of
the
forgotten
Skene's
glands:
A
review
of
current
literature,
Pol
Ann
Med.
(2016),
http://dx.doi.org/10.1016/j.poamed.2016.02.007
abscess
is
either
conservative
or
surgical.
Conservative
treatment
involves
antibiotics
and
waiting
abscess
drainage.
Incision
and
drainage,
simple
aspiration,
or
drainage
with
marsupialization
are
appropriate
forms
of
treatment.
120122
Shah
et
al.
conducted
a
retrospective
study
observing
surgical
management
of
Skene's
gland
abscess.
The
study
group
involved
34
women
who
had
undergone
excision
of
the
abscess.
According
to
this
study,
88.2%
of
women
had
resolution
of
symptoms,
30.0%
eventually
had
recurrence
of
symptoms
requiring
further
treatment,
and
85.3%
had
complete
resolution
of
symptoms
after
all
treatment.
Patients
whose
symptoms
continued
mainly
complained
of
urethral
pain
and
frequent
urinary
tract
infections.
124
4.8.
Infections
of
the
Skene's
glands
Gonorrhea,
tuberculosis,
and
trichomoniasis
are
harbored
in
the
skene's
glands
along
with
other
parts
of
the
vagina.
The
infection
may
be
asymptomatic.
125,126
4.9.
Benign
and
malignant
tumors
of
Skene's
glands
4.9.1.
Benign
tumor
of
Skene's
glands
Tubulo-squamous
vaginal
polyps
are
immune
positive
for
prostatic
specic
antigen
suggestive
of
displaced
periurethral
Skene's
glands.
22
4.9.2.
Malignant
tumors
of
Skene's
glands
4.9.2.1.
Urethral
adenocarcinoma
arising
from
Skene's
glands.
Urethral
adenocarcinomas
are
rare,
and
some
reports
have
described
them
to
be
of
Skene's
gland
in
origin.
Common
clinical
presentation
includes
painless
urethral
bleeding,
enlarged
urethral
mass,
urinary
frequency,
urethral
obstruc-
tion,
focal
tenderness,
urinary
tract
infections,
and
urethror-
rhagia,
because
these
symptoms
are
not
specic
to
urethral
adenocarcinoma.
127
Furthermore,
due
to
its
rarity
and
vague
presentation,
delayed
diagnosis
may
occur.
Approximately
10
16%
of
all
urethral
cancers
are
adenocarcinoma.
14,128
Urethral
adenocarcinoma
has
been
shown
to
originate
from
multiple
tissues
such
as
Skene's
glands,
Mullerian
ducts,
or
urethritis
gladularis.
129,130
Chan
et
al.
reported
a
case
of
a
72-year-old
woman
who
presented
with
a
urethral
mass,
conrmed
on
biopsy
to
be
an
adenocarcinoma.
Immunohistochemistry
testing
for
cytokeratin
7
(CK7)
and
cytokeratin
20
(CK20)
was
done
to
determine
if
the
tumor
was
epithelial
in
origin.
The
tumor
showed
expression
of
both
CK7
and
CK20,
making
the
tumor
unlikely
to
be
Mullerian
or
Skene's
gland
in
origin.
If
the
tumor
was
Skene's
gland
in
origin,
it
would
not
express
CK7.
129
However,
cases
of
urethral
adenocarcinomas
that
are
Skene's
gland
in
origin
have
been
reported.
Dodson
et
al.
conducted
a
study
looking
at
13
females
with
urethral
adenocarcinomas.
One
of
the
cases
histologically
appeared
to
be
prostatic
in
nature.
Staining
of
tumor
by
PSA
is
considered
a
histological
evidence
of
origin
from
Skene's
glands.
The
tumor
was
immune
histochemically
reactive
to
PSA
conrming
the
tumor's
origin
from
Skene's
glands.
Furthermore,
the
PSA
levels
declined
rapidly
after
removal
of
the
tumor
making
it
a
useful
marker
in
responsiveness
to
treatment.
14
Another
case
describes
a
70-year-old
woman
presenting
with
a
urethral
mass,
determined
to
be
adenocarcinoma
without
mucosal
involvement.
The
tumor
stained
positive
for
PSA
and
was
determined
to
be
Skene's
gland
adenocarcinoma.
Surgical
removal
of
the
tumor
resulted
in
a
sudden
drop
in
PSA.
131
If
the
urethral
tumor
stained
negative
for
PSA,
it
may
still
have
been
Skene's
gland
in
origin.
Reis
et
al.
described
two
cases
of
Skene's
gland
adenocarcinoma
both
of
which
were
PSA
negative.
The
tumors
etiologies
were
conrmed
based
on
gross
and
microscopic
ndings,
which
resembled
Skene's
glands.
Not
all
cells
of
the
Skene's
gland
produce
PSA;
therefore
it
is
plausible
to
have
a
Skene's
gland
adenocarcino-
ma
stain
negative
for
PSA.
132
Treatment
of
urethral
adenocar-
cinoma
usually
involves
surgical
resection,
and
sometimes
chemoradiation.
Chen
et
al.
report
two
cases
of
locally
invasive
urethral
adenocarcinoma.
One
patient
underwent
surgical
resection,
dying
2
months
later
due
to
disease
progression.
The
other
patient
had
surgery
and
chemoradiation,
and
was
disease
free
for
approximately
6
months,
which
is
an
improvement
compared
to
the
expected
median
disease
free
period
of
5.5
months.
This
study
recommended
adjuvant
chemoradiation
for
locally
advanced
urethral
adenocarcino-
mas.
133
4.9.2.2.
Adenoid
cystic
carcinoma.
Skene's
gland
has
also
been
associated
with
adenoid
cystic
carcinoma.
Ali
reported
a
50
year
old
woman
with
adenoid
cystic
carcinoma
of
Skene's
glands,
which
presented
as
a
suburethral
mass,
biopsy
revealed
adenoid
cystic
carcinoma
arising
from
the
Skene's
gland.
Along
with
glandular
tissue
the
tumor
also
contained
cystic
material
that
stained
for
periodic
acidSchiff.
The
tumor
showed
extensive
nerve
involvement
and
stained
positive
for
cytokeratins,
carcinoembryonic
antigen,
and
S-100
protein.
104
Ueda
et
al.
described
a
rare
case
of
adenoid
cystic
carcinoma
that
arose
from
Skene's
glands,
where
the
best
course
of
action
was
surgery.
However,
in
this
case,
the
tumor
had
invaded
more
extensively
and
required
pelvic
exenteration
with
radical
vulvectomy.
134
In
order
to
avoid
more
radical
treat-
ment
options,
precise
preoperative
assessment
is
necessary.
5.
Conclusions
Anatomy,
embryology,
and
clinical
pathology
of
the
Skene's
glands
and
its
ducts
are
discussed
in
this
paper.
The
role
of
PSA
in
Skene's
glands,
which
can
simulate
prostate
cancer,
is
reviewed.
Differential
diagnosis
that
simulates
lesions
of
Skene's
glands
and
ducts
is
addressed.
Current
imaging
of
these
rare
lesions
is
useful
to
radiologists,
clinical
pathologists,
and
clinicians.
Conict
of
interest
The
authors
declare
they
have
no
conict
of
interest.
Acknowledgements
We
gratefully
acknowledge
literature
research
assistance
from
Mrs.
Wendy
Isser,
Ms.
Grace
Garey,
and
Ms.
Amanda
Dalpiaz.
p
o
l
i
s
h
a
n
n
a
l
s
o
f
m
e
d
i
c
i
n
e
x
x
x
(
2
0
1
6
)
x
x
x
x
x
x
5
POAMED-164;
No.
of
Pages
9
Please
cite
this
article
in
press
as:
Dagur
G,
et
al.
Clinical
implications
of
the
forgotten
Skene's
glands:
A
review
of
current
literature,
Pol
Ann
Med.
(2016),
http://dx.doi.org/10.1016/j.poamed.2016.02.007
r
e
f
e
r
e
n
c
e
s
1.
Skene
AJC,
Alex
S,
Tulsky
MD.
History
of
Medicine
Collection.
The
Anatomy
and
Pathology
of
Two
Important
Glands
of
the
Female
Urethra.
New
York:
William
Wood
&
Co.;
1880.
2.
de
Graaf
R.
De
Mulerium
Organis
Generationi
Inser-ventibus
Tracatus
Novus,
Demonstrans
Tam
Hominesset
Aminalis
Caetera
Omina,
Quac
Vivipara
Dicuntur,
Haud
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