Lymphangioma of the ovary accompanied by chylous ascites Takeshi Iwasa 1 , Anna Tani 1 , Yuka Miyatani 1 , Shirou Bekku 1 , Michiko Yamashita 2 , Kazuyo Nakanishi 2 , Yoshiyuki Fujii 2 and Hiroyasu Ino 1 Divisions of 1 Obstetrics and Gynecology and 2 Pathology, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan Abstract Lymphangioma of the ovary is very rare, with only 17 cases reported to date. In this report, a 43-year-old woman with lymphangioma of the ovary accompanied by chylous ascites is described. Vaginal ultrasound showed a solid cystic tumor at the right ovary accompanied by ascites. The volume of ascites was changeable. Milky fluid obtained by Douglas pouch aspiration contained numerous mature lymphocytes. She underwent right salpingo-oophorectomy. Histological examination revealed that the excised tumor from the right ovary was consistent with benign lymphangioma. This is the first case report of lymphangioma of the ovary accom- panied by chylous ascites. We should discriminate such cases from other malignant tumors in order to avoid overtreatment. Key words: chylous ascites, lymphangioma, ovarian tumor. Introduction Lymphangioma of the ovary is a very rare tumor. It was first described in 1908 1 and as of 2006, around 17 cases have been reported in the literature. 2 In most cases, lymphangiomas of the ovaries are classified as cavern- ous, and they are filled with serous or chylous fluid. 3–7 However, the histogenesis of this tumor is uncertain and controversial, as the tumor is usually silent and is encountered incidentally, for example, via surgery and biopsy. Herein, we report a case of lymphangioma of the ovary accompanied by chylous ascites. Case Report A 43-year-old woman, gravida 3, para 3, presented to the gynecological outpatient department of Tokushima Red Cross Hospital with a right ovarian tumor, which was pointed out during gynecological cancer screening at a previous hospital. She had no obvious symptoms. Her history was unremarkable and her menstrual periods were regular (26-day cycle). Physical examina- tion, including pelvic and adnexal evaluation, was within normal limits. Tumor markers, CA19-9, CA125 and STN, were within normal ranges. Vaginal ultra- sound showed a 4.1 cm ¥ 4.0 cm ¥ 3.4 cm cystic solid tumor at the right ovary accompanied by ascites in the Douglas pouch. The volume of ascites varied with the menstrual cycle (0.5cm on day 3, 3 cm on day 14) (Fig. 1). The left ovary and uterus were normal. On magnetic resonance imaging, the tumor had low signal intensity on T1-weighted images and high signal inten- sity on T2-weighted images. Part of the tumor was enhanced (Fig. 2). Initially, we aspirated the ascites from the Douglas pouch. The ascites had a milky appearance. Cytologi- cal examination revealed bland-looking, small lympho- cytes of a chylous background (Fig. 3). The patient underwent abdominal right salpingo- oophorectomy. The cyst wall was unruptured, thick and corrugated (Fig. 4). The left ovary, uterus, peritoneum and mesenterium were unremarkable. Received: April 28 2008. Accepted: October 10 2008. Reprint request to: Dr Takeshi Iwasa, MD, PhD, Division of Obstetrics and Gynecology, Tokushima Red Cross Hospital, Irinokuchi 103, Komatsushima-cho, Komatsushima-city, Tokushima 773-8502, Japan. Email: takeshi1@clin.med.tokushima-u.ac.jp. doi:10.1111/j.1447-0756.2009.01016.x J. Obstet. Gynaecol. Res. Vol. 35, No. 4: 812–815, August 2009 812 © 2009 The Authors Journal compilation © 2009 Japan Society of Obstetrics and Gynecology