Huge broad ligament leiomyoma with cystic degeneration: A diagnostic and surgical challenge

Abstract

Broad ligament is the common extrauterine site for fibroid. We present a case of huge broad ligament fibroid with cystic degeneration. Patient presented with abdominal swelling and mild pain abdomen. On abdominal examination, a large tense cystic mass of 34 weeks gravid uterus size arising from pelvis was noted. Cervix was pulled up and all fornices were full with mass on pelvic examination. Ultrasound suggested adnexal mass as ovaries were not seen. Contrast-enhanced computed tomography abdomen too reported adnexal mass likely of ovarian origin. On laparotomy, 6 L of straw color fluid drained from the mass which was seen arising from left broad ligament, bilateral ovaries were separate from the mass and appeared healthy. Enucleation of mass was done to ease the hysterectomy and careful evaluation of ureteric course was done throughout the surgery to avoid its injury. Total hysterectomy with bilateral salpingo-opherectomy and pelvic lymphadenectomy was performed. This case is being reported for its rare incidence, diagnostic dilemma and surgical challenge.

Gigantic parasitic leiomyoma of 19 kg in a postmenopausal woman: A case report and review of the literature

“…Leiomyomas are the most common benign tumors of the female genital tract 1 . They arise most often from the uterus, but can also grow on other extrauterine sites, from which the broad ligament is the commonest 3 . Kelly and Cullen were the first to describe parasitic fibroids in 1909 4…”

“…As doing so, the attachment to the uterus is lost 4 . Additionally, it has been suggested that leiomyomas adherent to the broad ligament originate directly from hormonally sensitive smooth muscles of the mesometrium 3 . Distinction between the two types is difficult as histopathology and immunohistochemical features are identical for all estrogen receptor‐positive leiomyoma of Mullerian derivation 5 …”

“…This case report demonstrates the diagnostic challenge of large intra‐abdominal masses. A parasitic fibroid may mimic ovarian malignancy on clinical examination and ultrasound, especially in postmenopausal women 3 . Transvaginal sonography can be useful in diagnosing parasitic leiomyoma if ovaries and uterus can be clearly visualized separate from the abdominal mass 3,12,13 .…”

“…A parasitic fibroid may mimic ovarian malignancy on clinical examination and ultrasound, especially in postmenopausal women 3 . Transvaginal sonography can be useful in diagnosing parasitic leiomyoma if ovaries and uterus can be clearly visualized separate from the abdominal mass 3,12,13 . In case of diagnosing a giant abdominal mass, parasitic leiomyoma should be kept in differential diagnosis, even without prior history of surgery 13 …”

Robotic Resection of a Large Degenerating Leiomyoma

“…A review of the literature demonstrates 19 cases of degenerated fibroids that were misdiagnosed as an ovarian malignancy on imaging prior to surgery [6][7][8][9]. the left sidewall to the para-vesicle space.…”