MRI Characteristics of Bartholin Gland Nodular Hyperplasia

Bartholin gland nodular hyperplasia is a rare benign solid lesion that clinicians often mistake for a Bartholin gland cyst. Although histologic criteria for Bartholin gland nodular hyperplasia were defined in 1998, the literature still lacks clear imaging descriptors. This article aims to define the MRI features of Bartholin gland nodular hyperplasia and proposes an imaging appearance that distinguishes Bartholin gland nodular hyperplasia from other Bartholin gland entities. We describe three patients (28–31 years old) who underwent pelvic MRI; these three pathologically confirmed cases of Bartholin gland nodular hyperplasia are presented with correlation to MRI findings. All examinations used multiparametric MRI (i.e., T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences). All cases shared a consistent MRI pattern: nodular gland enlargement, low T2 signal isointense to muscle, scattered cystic change (if and when present) with iso- to minimally hyperintense precontrast T1 signal, homogeneous enhancement, and no restricted diffusion. Histopathology confirmed nodular hyperplasia with proliferated mucinous acini, preserved ductal-to-acinar architecture, and mucin extravasation. The cases presented here share a distinctive MRI signature that supports preoperative diagnosis and helps distinguish Bartholin gland nodular hyperplasia from cysts and malignancy. Recognizing this pattern can direct management and may avert unnecessary surgery in asymptomatic patients.