Misplaced Skeneʼs Glands

Abstract

So-called ectopic prostatic tissue in the cervix and vaginal tubulosquamous polyps are rare morphologically similar lesions that may show positive immunohistochemical staining with prostatic markers. It has been suggested that they are related to paraurethral Skene's glands that are the female equivalent of prostatic glands in the male. We report a large series of lesions in women aged 23 to 81 years, found within the cervix (n=24), vagina (n=10), and vulva (n=2), which we believe to be a part of a spectrum of lesions derived from Skene's glands, either eutopic or more commonly misplaced during embryonic development. In all cervical cases, the lesion was predominantly situated in the ectocervix and was an incidental finding in specimens procured for a variety of reasons. In the vagina, the lesions usually presented themselves as polyps or cysts, although occasionally they were an incidental finding. The 2 vulval cases were incidental findings in punch biopsies. The basic morphological features were of epithelial elements of both glandular and squamous type; in some cases, the glandular elements formed a double cell layer. Uncommon findings included the presence of sebaceous glands in 2 cases (1 cervix, 1 vagina), basaloid formations resembling hair follicle structures in 4 (2 cervix, 2 vagina), and a microglandular proliferation resembling nephrogenic adenoma in 1 vaginal case. Prostate-specific antigen was positive in 13 of 26 cases and prostatic acid phosphatase in 16 of 26 tested. Six cases were negative with both markers. We propose that these benign lesions in the cervix, vagina, and vulva are derived from eutopic or misplaced Skene's glands.

Uncommon Cervical Lesions: A Review and Discussion of the Differential Diagnosis

“…Prostatic-type tissue in the female genital tract is a phenomenon first described in the uterine cervix in 1997, 90 with subsequent literature expanding the clinicopathologic picture of the lesions. [91][92][93][94][95][96][97][98][99][100] The prostatic-type tissue is composed of glands identical in morphology and immunohistochemical staining to male prostatic glands, and frequently lined by basal cells (Figure 7, A). Early studies reported the presence of prostatic glands within the lamina propria of the uterine cervix, sparing the squamous epithelium, but with frequent and often extensive squamous metaplasia in the prostatic-type glands, with the potential for misdiagnosis as squamous cell carcinoma when identified deep within the stroma (Figure 7, B through D).…”

“…Most cases in these early studies were identified incidentally during evaluation of squamous intraepithelial lesions, with rare presentation as a clinically identified mass. 91 Immunohistochemically, the lesions have been reported to be reactive with prostate- specific antigen, [90][91][92][93][94][95]97,99,100 prostate-specific acid phosphatase, [90][91][92][93][94][95]97,100 androgen receptor, 99,100 NKX3.1, 98,99 and CK7. 99 High-molecular-weight CK shows positivity in the basal cell layer if present.…”

“…99 High-molecular-weight CK shows positivity in the basal cell layer if present. 91,92,94,95,100 In one study, ER and progesterone receptor (PR) staining were performed and were negative in the glands, with the exception of ER positivity in areas of squamous metaplasia. 100 The origin of the prostatic-type glands in the cervix is not completely understood, but they have been theorized to arise from teratomatous tissue, developmental abnormalities (such as misplacement of paraurethral Skene glands during embryonic development), mesonephric remnants, or metaplasia of endocervical glands.…”

“…92,99 Similar lesions have been described in the vagina (tubulosquamous polyps) and vulva. [95][96][97][98][99] While most studies have reported only involve-ment of the lamina propria with an uninvolved squamous and endocervical glandular epithelium, a recent study 99 described prostatic-type tissue present within the squamous epithelium of the vagina and ectocervix in patients with androgen excess (most commonly, long-term testosterone therapy for gender dysphoria).…”