Broad Ligament Lipoleiomyoma Masses: Two curious cases masquerading as ovarian carcinomas

Abstract

Lipoleiomyomas account for approximately 0.03-0.2% of all uterine leiomyomas and are comprised of a mixture of variable amounts of mature adipocytes and smooth muscle cells. [1][2][3] Lipoleiomyomas typically occur in older post-menopausal women, whereas leiomyomas occur mostly in women of reproductive age and usually regress after menopause.2,3 The most common location of a lipoleiomyoma is the uterus, while other reported sites include the cervix, ovaries and, on occasion, the retroperitoneum.2-4 However, lipoleiomyomas on the broad ligament-a peritoneal fold that connects the uterus to the pelvis-are extremely uncommon, with only seven cases reported in the literature to date. 2,[5][6][7][8][9][10] Broad ligament lipoleiomyomas are difficult to diagnose preoperatively upon radiology and may be mistaken for an ovarian carcinoma.11 However, it is important to distinguish between these entities as broad ligament lipoleiomyomas can be treated conservatively with a lumpectomy.6 This report describes two cases of broad ligament lipoleiomyoma in which both patients were initially diagnosed with a solid malignant adnexal mass. Case OneA 15-year-old girl was admitted to the Lok Nayak Jai Prakash Hospital (LNJPH), New Delhi, India, in 2016 with lower abdominal discomfort and an abdominal mass of three months' duration. The patient's past medical history was insignificant. She had first undergone menarche at the age of 12 years. A physical examination revealed a hard movable mass in the lower abdomen of a size similar to a pregnancy of 20 gestational weeks. There was no evidence of lymphadenopathy or organomegaly. Magnetic resonance imaging (MRI) showed a well-defined, large, solid, cystic abdominopelvic mass measuring 26 x 26 x 14.5 cm. The mass was abutting the posterior wall of the urinary bladder, uterus, anterior wall of the rectum and the retroperitoneal structures, displacing the uterus and reaching up to the lower margin of the liver [ Figure 1]. Laboratory tests revealed raised levels of serum thyroid-stimulating hormone (14.74 µIU/mL) and total triiodothyronine (T3; 60 ng/dL), although her thyroxine (5.42 µg/dL) and free T3 (2.2 ng/dL) levels were normal. Based on these clinical and radiological features, the patient was diagnosed with an ovarian tumour. Lipoleiomyomas are an extremely rare form of uterine leiomyoma; moreover, the occurrence of this type of tumour on the broad ligament is even rarer. We report two cases of broad ligament lipoleiomyomas in 15-and 38-year-old female patients who presented to the Lok Nayak Jai Prakash Hospital in New Delhi, India, between 2016 and 2017. In both cases, the preoperative diagnosis was of a solid ovarian malignancy. Most broad ligament tumours are mistaken for ovarian masses as they are difficult to diagnose radiologically.

True broad ligament fibroid mimicking ovarian mass in a postmenopausal woman

“…6 Fibroids in the broad ligament though not so common, but are well known for achieving enormous size, which may mimic a malignancy of the pelvis thereby altering the course of treatment offered. [7][8][9] This case reports a patient who presented with pain lower abdomen and mass per abdomen that seem to be arising out of the pelvis, had features of malignancy both clinically and radiologically and exploratory laparotomy was done for the same while intra-operative findings and histopathology confirmed it as a benign broad ligament fibroid. A similar case report has been reported by Gowri et al, for its diagnostic difficulties.…”

Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review

“… [62] 1 Broad ligament lipoleiomyoma Yadav et al. [63] 2 Broad ligament lipoleiomyoma Agarwal et al. [64] 1 Broad ligament lipomyosarcoma …”

Recurrent Large Extrauterine Lipoleiomyoma in a Postmenopausal Woman: A Case Report

“…A biopsy with histological analysis is required to make an accurate diagnosis of the lipoleiomyoma. Although the most common location for this tumor is the uterine corpus [1,4], it has been found in other sites, including the breast [5], the broad ligament of the uterus [6], and intraperitoneal [7]. Most patients will present with abdominal cramping and symptoms similar to a leiomyoma, including pelvic pain, a noticeably enlarged mass of the abdomen, and dysmenorrhea.…”