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.