The uterus with attached cervix measured 22x16x11 cm and weighed 1722 g. The specimen demonstrated a subserosal multilobulated firm nodular mass measuring approximately 18 cm and an intramural leiomyoma. The cut surface was white to tan with a whorled trabecular appearance. No hemorrhage or necrosis was observed. In the left fallopian tubae, a multilocular cyst measuring 4 cm and containing clear, serous, gelatinous fluid, was resected. The microscopic examination of the cystic mass showed a tumor composed of numerous, thin-walled, cystic spaces containing a proteinaceous fluid, mature lymphocytes, and occasional erythrocytes (Fig- 1). The cyst walls were lined by flat, benign-appearing cells that were immunoreactive for CD34 (Fig–2,3). At the periphery of the mass, fallopian tube tissue was apparent. The diagnosis was Lymphangioma of the fallopian tube. Histopathologic examination of the ovaries and subserosal mass revealed corpus albicans, inclusion cysts, ovarian fibroma and leiomyoma uteri, respectively. The patient was discharged without complication.

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Figure 1: The dilated lymphatic channels lined by a single layer of bland appearing endothelium (H&E, x100, original magnification)

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Figure 2: The lymphatic channels were lined by flat, benignappearing cells that were immunoreactive for CD34 (CD 34, x100 and x 200 respectively, original magnification)

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Figure 3: The lymphatic channels were lined by flat, benignappearing cells that were immunoreactive for CD34 (CD 34, x100 and x 200 respectively, original magnification)

Lymphangiomas tend to occur in the first two years of life. They can occur at any age and most are asymptomatic. Lymphangiomas, regardless of their location, are all benign lesions. The most common presenting clinical symptoms are related to the size of the lesion. The size of the lesion is more important than its location to the symptomatology development.

The etiology of the lymphangioma is unclear, with both reactive and neoplastic etiologies being postulated. There are reports that the tumours can behave in a malignant manner and should be followed up for a period of at least 2 years to exclude recurrence ⁵. However most investigators regard lymphangiomas as malformations arising from sequestered lymphatic channels or acquired lesions due to obstruction caused by fibrosis of lymph channels ^4,6. In our patient the large leiomyoma may be responsible for the impaired lymphatic drainage.

Almost all lymphangiomas are benign, but they can compress and infiltrate vital structures. We think that most tumors remain undetected or unreported. The diagnosis of suspicion is radiological by means of abdominal ultrasonography and computed tomography. Treatment of choice is always surgical and a complete extirpation should be performed for definitive diagnosis and viable treatment.

In an old female patient presenting with a large cystic pelvic mass, lymphangioma of the fallopian tube should be considered as a possible diagnosis. And impaired lymphatic drainage may be responsible for the development of lymphangioma of the fallopian tube.

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2) Sanes S, Warner R. Primary lymphangioma of the fallopian tube. Am J Obstet Gynecol 1939;37: 316–321.

3) Nigam S, Sharma D, Manaktala U, Chaturvedi KU. Lymphangioma of the fallopian tube--a case report. Indian J Pathol Microbiol 2004; 47: 225–226.

4) Evans A, Lytwyn A, Urbach G, Chapman W. Bilateral lymphangiomas of the ovary: an immunohistochemical characterization and review of the literature. Int J Gynecol Pathol 1999; 18: 87–90.

5) Khanna S, Mehrotra ML, Basumallick MK. Lymphangioma cavernosum of the ovary. Int Surg 1978; 63: 104–105.

6) Gui L, Bigler SA, Subramony C. Lymphangioma of the pancreas with "ovarian-like" mesenchymal stroma: a case report with emphasis on histogenesis. Arch Pathol Lab Med 2003; 127: 1513- 1516.