Atypical retroperitoneal lymphocoeles with large leiomyoma of uterus

Case contributed by Nafisa Shakir Batta


Postmenopausal female with enlarging abdominal lump, urinary frequency and dull aching backache.

Patient Data

Age: 50 years
Gender: Female

CT reveals markedly enlarged uterus with a large lobulated heterogenously enhancing solid mass lesion arising from posterior body and fundus of uterus, appearance in keeping with leiomyoma.

Also evident is a large non-enhancing cystic lobulated retroperitoneal lesion extending from lower pole of right kidney up to the right adnexa, inseparable from the right uterine margin.

A similar smaller cystic lesion was seen at left adnexa .

Right pleural effusion is seen. An incidental hepatic hemangioma is observed.

Non-contrast MRI study of pelvis reveals markedly enlarged uterus with a large globular heterogenous hypervascular sharply demarcated leiomyoma arising from posterior body and fundus of uterus.

A concurrent large cystic lobulated longitudinally oriented  retroperitoneal lesion with thin septae and loculations is seen, which is distinctly separate from  uterine margin (helps to rule out mesenchymal malignancy). Dilated tortous flow voids are seen through it.  A similar smaller cystic lesion was seen at left adnexa.

Case Discussion

Large hypervascular Uterine leiomyoma with bilateral retroperitoneal lymphatic obstruction.  Differential of bilateral coexistent retroperitoneal lymphangioma was also conveyed.

Intraop findings revealed a well-encapsulated uterine myoma, with dilated lymphatic channels. A hysterectomy was performed, and lymphatics ligated at pelvis. Histopathology of the myoma revealed no mitotic elements.

The repeat MRI showed regression of these dilated lymphatics and resolution of pleural effusion on conservative treatment.

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