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Αdnexal cystic lymphangiomas in patients with massive leiomyomatous uterus: a not so uncommon finding on pelvic MRI

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Abstract

Purpose

To investigate any association between the presence of an adnexal cystic lymphangioma (ACL) and an enlarged leiomyomatous uterus.

Methods

A retrospective observational study was conducted by two expert radiologists using a 10-year MRI database (2008–2018); 85 patients (mean age: 45.5 years ± 10.9) were considered eligible due to the presence of a single (n = 31) or multiple (n = 54) leiomyomas causing distortion of the uterine contour and uterine enlargement. The association of specific leiomyoma features (longest diameter (Dmax), location, number) and uterine volume with the presence of ACL was statistically tested. Diagnosis of ACL was based on typical imaging features (n = 14) and intraoperative/histological findings (n = 3).

Results

ACL (unilateral = 9, bilateral = 8) was recorded in 17/85 (20%) of patients; it was more frequently observed when the largest leiomyoma was located in the uterine fundus (33.3%). Patients with ACL had significantly more leiomyomas (median: 5 vs. 2, p = 0.043), greater Dmax of largest leiomyoma (median: 13.3 vs. 7.2 cm, p < 0.001), and larger uterine volumes (median: 676.7 vs. 223.1 cm3, p < 0.001) compared to patients without ACL. ROC curve analysis for a number of leiomyomas showed that the optimal cut-off for the prediction of ACL was the presence of 5 leiomyomas with 53.8% sensitivity and 84% specificity (AUC = 0.65, 95% CI 0.51–0.83, p = 0.049), Dmax of largest leiomyoma 9.1 cm with 76.5% sensitivity and 77.9% specificity (AUC = 0.83, 95% CI 0.73–0.94, p < 0.001), and uterine volume 311 cm3 with 71% sensitivity and 75% specificity (AUC = 0.79, 95% CI 0.66–0.92, p < 0.001).

Conclusions

The presence of ACL is significantly associated with number of leiomyomas, Dmax of largest leiomyoma, and uterine volume; prospective evaluation of our results is needed to investigate its clinical significance.

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Abbreviations

ACL:

Adnexal cystic lymphangioma

AUC:

Area under the curve

C-section:

Cesarean section

Dmax:

Maximal diameter

FIGO:

Federation international of gynecology and obstetrics

MDCT:

Multidetector computed tomography

MRI:

Magnetic resonance imaging

ROC:

Receiver operating characteristic

SI:

Signal intensity

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Authors and Affiliations

  1. Department of Radiology, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, 76 Vassilisis Sofias Ave, Athens, 11528, Greece

    Charis Bourgioti, Konstantinos Chatoupis, Konstantina Zafeiropoulou, Evangelia Panourgias, Aristeidis Antoniou & Lia Angela Moulopoulos

  2. Department of Health, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 25 Alexandroupoleos Str, Athens, 11527, Greece

    Chara Tzavara

Authors
  1. Charis Bourgioti
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  2. Konstantinos Chatoupis
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  3. Chara Tzavara
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  4. Konstantina Zafeiropoulou
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  5. Evangelia Panourgias
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  6. Aristeidis Antoniou
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  7. Lia Angela Moulopoulos
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Correspondence to Charis Bourgioti.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Bourgioti, C., Chatoupis, K., Tzavara, C. et al. Αdnexal cystic lymphangiomas in patients with massive leiomyomatous uterus: a not so uncommon finding on pelvic MRI. Abdom Radiol 45, 537–546 (2020). https://doi.org/10.1007/s00261-019-02106-z

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