Bilateral massive ovarian oedema--report of a case due to lymphangiitis carcinomatosa

A 40 year-old Caucasian woman, with clinical and radiological evidence of pulmonary lymphangiitis carcinomatosa presented with weight loss, productive cough and lower abdominal pain. At operation, she was found to have massive bilateral ovarian oedema. No abdominal primary tumour was found. A transbronchial biopsy showed extensive infiltration by a poorly differentiated, focally necrotic cribriform adenocarcinoma and there was extensive lymphatic permeation by this metastatic carcinoma in the stroma of the cervix uteri, myometrium, mesosalpinx, mesoovarii, surface of the ovaries, rectosigmoid colonic wall and peritoneal fat. The cut surface of the enlarged, soft and fluctuant ovaries oozed oedema fluid readily. Histologically, there was wide separation of the stromal cells by oedema in the ovaries which contained many dilated lymphatics. Compression and collagenization of the outer cortex was noted. The pathogenesis of the massive ovarian oedema was apparently due to neoplastic obstruction of the lymphatic system.