Diagnostic Challenges of an Unusually Large Bartholin Duct Cyst in a Postmenopausal Woman: Clinical, Ultrasound, MRI, and Histopathological Correlation

Bartholin duct cysts are common benign vulvar lesions, but unusually large cysts in postmenopausal women are rare and may raise concern for malignancy. We report a 56‐year‐old postmenopausal woman with a progressively enlarging right‐sided vulvar mass that was initially misdiagnosed at multiple healthcare levels as a urinary tract infection and a labial abscess. Clinical examination revealed a large, nontender vestibular mass arising from the right Bartholin gland region. Transperineal ultrasound demonstrated a cystic lesion with heterogeneous internal echoes and no internal vascularity. Noncontrast MRI demonstrated a well‐circumscribed purely cystic lesion measuring 5.9 × 5.4 × 4.0 cm with no enlarged regional lymph nodes or invasion of adjacent structures. Surgical marsupialization was performed, and histopathological analysis confirmed a benign Bartholin duct cyst. The patient had an uneventful postoperative course and no recurrence on follow‐up. This case highlights that atypically large Bartholin duct cysts should be considered in the differential diagnosis of vulvar masses in postmenopausal women. Ultrasound and MRI can help characterize lesion morphology and extent, but histopathological confirmation remains essential in atypical presentations to exclude malignancy.