 Adenocarcinoma can arise from the Bartholin gland and present with a painful lump.Two main pathophysiological pathways are currently understood to contribute to development of vulvar cancer - human papillomavirus (HPV) infection and chronic inflammation or autoimmunity affecting the vulvar area.HPV DNA can be found in up to 87% of vulvar intraepithelial neoplasia (VIN) and 29% of invasive vulvar cancers; HPV 16 is the most commonly detected subtype in VIN and vulvar cancer, followed by HPV 33 and HPV 18.