LAUSR

Sir, Despite ovaries normally exhibiting a rich medullary vasculature, ovarian haemangiomas are extremely uncommon lesions and published examples, in the English and major nonEnglish language literature, remain in double figures. Reports are consistently single cases dating back to the mid-20th century while the first recorded case is from 100 years earlier. The largest reported series is 10 cases, and only infrequent retrospective reviews exist. Frequently they are incidental findings at surgery for unrelated gynaecological conditions or even at obstetric surgery, but may present because they occur in association with other clinically apparent ovarian neoplasms in the same or other ovary, or in their own right as symptomatic pelvic lesions. In the latter instance, clinical presentation may be abdominopelvic symptoms due to a mass, pain (e.g., torsion), ascites (pseudo-Meigs syndrome) and even clinical simulation of widespread abdominal malignancy. A solitary case presented as a heavily calcified adnexal mass, presumably on the basis of past torsion. Isolated cases have presented as part of more diffuse (abdominopelvic or systemic) haemangiomatoses, either at operation, or at autopsy. Surprisingly frequently, they may be associated with the clinical hormonal effects of associated ‘stromal hyperplasia’ or ‘luteinisation’. They usually occur in post-menopausal women (particularly the asymptomatic cases) and up to 87 years, but those lesions that present clinically are more likely to be in young women, children or even newborn infants. The vast majority are unilateral. The histological subtype is most frequently cavernous, accounting for approximately two-thirds of cases, but capillary haemangiomas occur either as pure variants or admixed with cavernous areas. Solitary cases of so-called anastomosing haemangioma, epithelioid haemangioendothelioma and infantile haemangioendothelioma (cellular haemangioma of infancy) have been reported, but these rare variants are likely not part of the dominant spectrum and represent separate entities altogether.