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Year : 2013  |  Volume : 56  |  Issue : 3  |  Page : 323-324
An unusual cystic ovarian neoplasm


Department of Pathology, Seth G. S. Medical College, Mumbai, Maharashtra, India

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Date of Web Publication24-Oct-2013
 

How to cite this article:
Sathe PA, Taware AC, Choudhari JP, Kandalkar BM. An unusual cystic ovarian neoplasm . Indian J Pathol Microbiol 2013;56:323-4

How to cite this URL:
Sathe PA, Taware AC, Choudhari JP, Kandalkar BM. An unusual cystic ovarian neoplasm . Indian J Pathol Microbiol [serial online] 2013 [cited 2022 Jan 23];56:323-4. Available from: https://www.ijpmonline.org/text.asp?2013/56/3/323/120416


Sir,

Lymphangiomas are benign tumors of the lymphatic system and may arise in any part of the body. [1] Ovary is an uncommon site. [1]

A 43-year-old woman came with the complaints of colicky right iliac fossa pain of 5 months duration. She had regular and painless menstrual cycles. The general and per abdominal examination was normal. On gynecologic examination, the uterus was anteverted. A mobile, non-tender mass measuring 5 × 3 cm in size was felt in the right fornix. Investigations showed normal hematologic, renal function and liver function parameters. Serum tumor markers namely cancer antigen -125, beta human chorionic gonadotropin and alphafetoprotein were within normal range. Ultrasonography and computed tomography of the abdomen and pelvis showed a heterogeneous, hyperechoic bulky left ovary with solid-cystic appearance measuring 5 × 4.7 × 4 cm. The right ovary, uterus and other organs were normal. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The left ovary measured 6 × 4 × 2.5 cm with pale and smooth external surface. The cut surface was entirely spongy with multiple small cysts filled with clear fluid [Figure 1]a and b. A single hemorrhagic area measuring 1.5 cm in diameter was seen at one pole. The uterus, the right ovary and both fallopian tubes did not show any abnormality. Histological examination of left ovary showed a neoplasm composed of vascular channels lined by widely spaced endothelial cells. The lumen of many channels contained mature lymphocytes and eosinophilic material suggestive of lymph. The stroma had aggregates of lymphocytes [Figure 1]c and d. Immunohistochemistry showed positivity for CD 34, thus confirming the endothelial origin [Figure 2]. A histopathology diagnosis of ovarian lymphangioma was given. The patient is asymptomatic 6 months post-operatively.
Figure 1: (a) Irregular and pale external surface of the affected ovary. (b) Cut surface of the tumor showing spongy appearance. (c) Tumor showing cystic spaces filled with eosinophilic fluid (H and E, ×40). (d) Cystic spaces are lined by interrupted endothelial cells. Lymphocytes are seen in the wall aswell as the lumen of the space (H and E, ×400)

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Figure 2: Endothelial cells are highlighted by CD 34 (×400)

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It is uncertain whether lymphangiomas represent true neoplasms, hamartomas or lymphangiectasis. They probably arise from sequestered lymphatic sacs that fail to communicate with the draining lymphatic channels or are secondary to mechanical pressure, trauma, previous surgery or radiation. [2] The common sites include head, neck, axilla and skin. [1] Less than 20 cases of ovarian lymphangiomas have been reported so far in the indexed literature. [1],[3] They are incidentally detected and are usually unilateral but can occasionally be bilateral. [3] Usually seen in adult women, lymphangiomas of ovary can rarely occur in children. [4] The histology differential diagnosis of lymphangioma of the ovary includes the more frequently observed hemangioma, secondary dilatation of lymphatic channels and an adenomatoidtumor. [2],[4] Hemangiomas show vascular spaces lined by continuous endothelial cells and lack lymphocytes in the wall. Secondary causes can be ruled out based on history and absence of stromal reaction. Adenomatoid tumor shows cystic spaces lined by continuous cuboidal or flattened mesothelial cells and do not show lymphocytes in the wall or stroma. The behavior of ovarian lymphangiomas is benign but few cases have recurred and occasional cases have shown transformation to a malignancy. [1]

To conclude,lymphangioma of ovary has to be included in the list of cystic neoplasms of the ovary. In all, less than 20 cases of ovarian lymphangiomas have been reported in indexed and non-indexed medical literature and hence the need for publishing this case. [1],[3],[4]

 
   References Top

1.Singer T, Filmar G, Jormark S, Seckin T, Divon M. Rare case of ovarian cystic l ymphangioma. J Minim Invasive Gynecol 2010;17:97-9.  Back to cited text no. 1
    
2.Evans A, Lytwyn A, Urbach G, Chapman W. Bilateral lymphangiomas of the ovary: An immuno his to chemical characterization and review of the literature. Int J Gynecol Pathol 1999;18:87-90.  Back to cited text no. 2
    
3.Akyildiz EU, Peker D, Ilvan S, Calay Z, Cetinaslan I, Oruc N. Lymphangioma of the ovary: A case report and review of the literature. J BUON 2006;11:91-3.  Back to cited text no. 3
    
4.Jain D, Saroha V, Singh M. Lymphangioma of the ovary. J Obstet Gynaecol 2009;29:260-1.  Back to cited text no. 4
    

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Correspondence Address:
Pragati A Sathe
Department of Pathology, Seth G.S. Medical College, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.120416

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