Skene’s Gland Adenocarcinoma
Skene Gland’s Adenocarcinoma (or Adenocarcinoma of Skene Gland) is a rare and malignant tumor that typically affects middle-aged and elderly women.
What are the other Names for this Condition? (Also known as/Synonyms)
- Adenocarcinoma of Skene’s Gland
- Adenocarcinoma of Skene Gland
- Skene’s Gland Cancer - Adenocarcinoma Type
What is Skene’s Gland Adenocarcinoma? (Definition/Background Information)
- Skene Gland’s Adenocarcinoma (or Adenocarcinoma of Skene Gland) is a rare and malignant tumor that typically affects middle-aged and elderly women
- The Skene glands are located near the urethra, above the vaginal opening. It is considered as the source of female ejaculation during sexual activity. The gland is likened to the male prostate gland
- Factors that may influence the development of Skene’s Gland Adenocarcinoma are currently unknown. However, general risk factors for the development of cervical and vulvar cancers include infection by human papilloma virus (HPV), certain hormonal medications, and smoking
- The tumor may cause pain, itching, and burning sensation. It can also lead to abnormal vaginal bleeding and painful sexual intercourse. A delayed diagnosis and treatment may result in metastasis to the groin (inguinal) lymph nodes
- The treatment of choice is a surgical excision with clear margins followed by radiation therapy or chemotherapy, as decided by the healthcare provider. In majority of cases, the prognosis is good with appropriate treatment
- Nevertheless, the prognosis of Skene Gland’s Adenocarcinoma depends upon many factors including the stage of the tumor and health status of the affected individual. There is also a possibility of metastasis, which may influence the outcome
Who gets Skene’s Gland Adenocarcinoma? (Age and Sex Distribution)
- Skene Gland’s Adenocarcinoma is a rare condition that generally affects women over the age of 40 years
- All racial and ethnic groups are at risk. This malignancy is not localized to certain parts of the world and can occur globally
What are the Risk Factors for Skene’s Gland Adenocarcinoma? (Predisposing Factors)
The risk factors for Adenocarcinoma of Skene Gland are generally unknown. However, the risk factors for cancers occurring in the cervical and vulvar region include:
- Infection with human papilloma virus (HPV)
- History of diethylstilbestrol (DES, a synthetic form of estrogen) use in mothers: Female children of women, who took this drug while pregnant, developed adenocarcinoma of vagina, more commonly than the rest of the population
- Lack of periodic/regular Pap smear tests
- Weakened immune system as a result of disease, such as AIDS, or due to immune-suppressing drugs
- Having the first child at a young age (before 17 years)
- Multiple pregnancies
Note: There are no specific risk factors established for Skene’s Gland Adenocarcinoma.
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Skene’s Gland Adenocarcinoma? (Etiology)
- The cause of Skene Gland’s Adenocarcinoma is generally unknown
- Genetic mutations have been suspected by researchers in some cases, but these have not been well-characterized
What are the Signs and Symptoms of Skene’s Gland Adenocarcinoma?
The signs and symptoms of Skene Gland’s Adenocarcinoma include:
- In majority of the cases, the condition is asymptomatic and does not present any signs or symptoms (during the initial period)
- The tumor may be single; though, it is not uncommon to find multiple tumors in an individual
- The skin lesions may appear as crusted ulcer, plaques, and nodules
- There may be pain, itching, and burning sensation
- It may ulcerate and bleed. Occasionally, after the ulcer heals, it may become ulcerated again
- In some cases, the carcinoma may appear more pigmented than surrounding skin
- Individuals with immunocompromised states have more aggressive tumors
Additionally, the tumor may cause the following signs and symptoms:
- Abnormal vaginal bleeding, vaginal discharge
- Pain during sex and bleeding after sexual intercourse
- Anemia (due to bleeding)
- Loss of weight, loss of appetite
How is Skene’s Gland Adenocarcinoma Diagnosed?
A diagnosis of Skene Gland’s Adenocarcinoma is made by:
- Complete physical examination with detailed medical history evaluation
- Examination by a dermatologist using a dermoscopy, a special device to examine the skin
- Radiological studies, such as ultrasound scan, CT and MRI scans, to determine the extent of tumor spread
- In some women, prostate specific antigen can be increased in blood
Although the above modalities can be used to make an initial diagnosis, a tissue biopsy of the tumor is necessary to make a definitive diagnosis to begin treatment.
- A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
- Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation
- Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely, electron microscopic studies to assist in the diagnosis
In case of metastatic tumors, the following diagnostic procedures can be used to procure the tissue sample:
- Fine needle aspiration (FNA) biopsy of the tumor
- Core biopsy or open biopsy of the tumor
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Skene’s Gland Adenocarcinoma?
The possible complications due to Skene Gland’s Adenocarcinoma could include:
- Discomfort, irritability of the affected region
- Painful or uncomfortable sexual intercourse
- Some reports have indicated that individuals with Skene’s Gland Adenocarcinoma have easy bleeding due to abnormal coagulation
- The tumor can metastasize to the lymph nodes of the groin and other regions of the body including the bones
- Severe emotional and psychological stress
- There is a high frequency of recurrence of the carcinoma following treatment
- Complications that arise from cancer therapy (such as due to chemotherapy or radiation therapy)
How is Skene’s Gland Adenocarcinoma Treated?
Early diagnosis and treatment of Skene Gland’s Adenocarcinoma is important to avoid complications such as metastasis to other regions. The treatment measures may include:
- In most cases, a wide surgical excision and removal of the entire tumor is the preferred treatment option. This may be followed by radiation therapy and/or chemotherapy
- The surgical removal of the tumor depends on the size and stage of the Skene’s Gland Adenocarcinoma. The surgical procedures performed could include:
- Hemivulvectomy, which is partial removal of vulva
- Total vulvectomy, which is complete removal of vulva: Sometimes, local lymph nodes may also be removed using total vulvectomy, with bilateral inguinal and femoral lymphadenectomy
- If the tumor size is large, then partial pelvic exenteration may be performed. During this procedure, all the cancer tissue and surrounding pelvic tissue is removed to decrease the bulk of the tumor. This is often followed by radiation therapy and chemotherapy
- If the tumor has metastasized (in rare cases), then a combination of chemotherapy, radiation therapy, and invasive procedures may be used to treat the tumor
- Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals
- Follow-up care with regular screening and check-ups are important and encouraged
How can Skene’s Gland Adenocarcinoma be Prevented?
- There are no specific preventative risk factors for Skene Gland’s Adenocarcinoma
- Regular medical screening at periodic intervals with blood tests, scans, and physical examinations, are mandatory, due to its metastasizing potential and possibility of recurrence. Often several years of active vigilance is necessary
What is the Prognosis of Skene’s Gland Adenocarcinoma? (Outcomes/Resolutions)
- In general, Skene Gland’s Adenocarcinoma is a malignant tumor. If metastasis (such as to the local lymph nodes) is observed, then the prognosis is guarded or unpredictable
- Tumors in their early stage with complete excisional treatment typically have good prognosis
- In cases of metastasis, its prognosis depends upon a set of several factors that include:
- Stage of tumor: With lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
- The surgical resectability of the tumor (meaning if the tumor can be removed completely)
- Overall health of the individual: Individuals with overall excellent health have better prognosis compared to those with poor health
- Age of the individual: Older individuals generally have poorer prognosis than younger individuals
- Whether the tumor is occurring for the first time or is a recurrent tumor. Recurrent tumors have a poorer prognosis compared to tumors that do not recur
- Response to treatment: Tumors that respond to treatment have better prognosis compared to tumors that do not respond so well to treatment
Additional and Relevant Useful Information for Skene’s Gland Adenocarcinoma:
- During embryological growth and development, the prostate gland in females starts to shrink and almost disappears. However, small glands still remain which are labeled Skene glands. In other words, the Skene glands are remnants of the prostate gland seen in males
- Vulvar cancer is the fourth most common malignancy of the female reproductive tract. Vulvar cancers are very uncommon
- Cervical cancer, the second most common cancer in women worldwide, is a malignant (capable of invading nearby and distant tissues) tumor of the cervix, which is the lower part of the uterus/womb
The following article link will help you understand cervical cancer:
What are some Useful Resources for Additional Information?
American Cancer Society (ACS)
1599 Clifton Road, NE Atlanta, GA 30329-4251
Toll-Free: (800) 227-2345
TTY: (866) 228-4327
National Cancer Institute (NCI)
U.S. National Institutes of Health
Public Inquiries Office
Building 31, Room 10A03
31 Center Drive, MSC 8322 Bethesda, MD 20892-2580
Phone: (301) 435-3848
Toll-Free: (800) 422-6237
TTY: (800) 332-8615
American Academy of Dermatology
930 E. Woodfield Road Schaumburg, IL 60173
Phone: (866) 503-SKIN (7546)
Fax: (847) 240-1859
References and Information Sources used for the Article:
Wolff, K., & Johnson, R. A. (2009). Fitzpatrick's color atlas and synopsis of clinical dermatology. McGraw-Hill Medical.
Thiers, B. H. (1989). Year Book of Dermatology 1988. Archives of Dermatology, 125(8), 1150.
Burns, T., & Breathnach, S. (1992). Rook's Textbook of dermatology Vol 4. London: Blackwell Scientific Publications, 1992.
Bolognia, J. L., Schaffer, J. V., Duncan, K. O., & Ko, C. J. (2014). Dermatology Essentials E-Book. Elsevier Health Sciences.
Holleb, A. I., Fink, D. J., & Murphy, G. P. (Eds.). (1991). American Cancer Society textbook of clinical oncology. Amer Cancer Society.
Niederhuber, J. E., M. B. Kastan, and W. G. McKenna. Abeloff's clinical oncology. Philadelphia: Churchill Livingstone/Elsevier, 2008.
Helpful Peer-Reviewed Medical Articles:
Dodson, M. K., Cliby, W. A., Keeney, G. L., Peterson, M. F., & Podritz, K. C. (1994). Skene's gland adenocarcinoma with increased serum level of prostate-specific antigen. Gynecologic oncology, 55(2), 304-307.
Pongtippan, A., Malpica, A., Levenback, C., Deavers, M. T., & Silva, E. G. (2004). Skene's gland adenocarcinoma resembling prostatic adenocarcinoma. International Journal of Gynecologic Pathology, 23(1), 71-74.
Zaviačič, M., Šidlo, J., & Borovský, M. (1993). Prostate specific antigen and prostate specific acid phosphatase in adenocarcinoma of Skene's paraurethral glands and ducts. Virchows Archiv A, 423(6), 503-505.
Flamini, M. A., Barbeito, C. G., Gimeno, E. J., & Portiansky, E. L. (2002). Morphological characterization of the female prostate (Skene's gland or paraurethral gland) of Lagostomus maximus maximus. Annals of Anatomy-Anatomischer Anzeiger, 184(4), 341-345.
Korytko, T. P., Lowe, G. J., Jimenez, R. E., Pohar, K. S., & Martin, D. D. (2012, September). Prostate-specific antigen response after definitive radiotherapy for Skene's gland adenocarcinoma resembling prostate adenocarcinoma. In Urologic Oncology: Seminars and Original Investigations (Vol. 30, No. 5, pp. 602-606). Elsevier.
Muto, M., Inamura, K., Ozawa, N., Endo, T., Masuda, H., Yonese, J., & Ishikawa, Y. (2017). Skene's gland adenocarcinoma with intestinal differentiation: A case report and literature review. Pathology international, 67(11), 575-579.
Sloboda, J., Zaviačič, M., Jakubovský, J., Hammar, E., & Johnsen, J. (1998). Metastasizing adenocarcinoma of the female prostate (Skene's paraurethral glands): histological and immunohistochemical prostate markers studies and first ultrastructural observation. Pathology-Research and Practice, 194(2), 129-136.
Zaviacic, M., & Ablin, R. J. (2000). The female prostate and prostate-specific antigen. lmmunohistochemical localization, implications of this prostate marker in women and reasons for using the term" prostate" in the human female. Histology and histopathology, 15(1), 131-142.