Leiomyoma cellulare in the broad ligament of the uterus

Abstract

There are only two reports on leiomyoma cellulare (LC) in the parametrium that have been published so far. Aim of the study was analysis of two cases of LC in the parametrium diagnosed postoperatively, and review of literature on the subject.Case 1: A 50-year-old patient was operated on for LC located in the right parametrium and concomitant malignant tumour in the right ovary. Leiomyoma cellulare was resected, hysterectomy and bilateral appendectomy performed, and bilateral iliac and obturator lymph nodes excised. Case 2: A 46-year-old patient was operated on for giant LC, on the left side, reaching the retroperitoneal space in the meso- and epigastrium. Leiomyoma cellulare was resected, and hysterectomy and bilateral appendectomy performed. The patient was reoperated twice due to haemorrhage within 24 hours following the operation. A literature review found reports on two cases of LC in 29- and 50-year-old patients with LC in the parametrium, located on the right and left side, respectively.Casuistic location of LC in the parametrium justifies reporting the cases in the literature. Preoperative diagnosis of LC in the parametrium is difficult. Conservative treatment, i.e. myomectomy should be reserved for those patients who wish to maintain fertility.

Diagnostic performance of preoperative MR imaging findings for differentiation of uterine leiomyoma with intraligamentous growth from subserosal leiomyoma

“…They sometimes grow laterally between the folds of broad ligaments and subsequently extend into the retroperitoneum, called intraligamentous leiomyoma, accounting for 6.3% of uterine leiomyoma [4][5][6][7][8]. They tend to become large without symptoms and impinge on the ureter or fallopian tube, causing hydronephrosis or infertility [4][5][6][7][8][9].…”

“…Accurate preoperative diagnosis of intraligamentous growth of uterine leiomyoma would allow careful preoperative planning to reduce these surgical risks: selection of the surgical method, the possibility of fertility preservation, and measures to avoid injury of the ureter, bladder, and intestine. If necessary, preoperative countermeasures such as ureteral stenting, participation of multi-specialist operators, and preparation of autologous blood transfusion can be considered [4,9,13,16].…”

Cotyledonoid Leiomyoma Clinical Characteristics, Imaging Features, and Review of the Literature

“…This tumor can present as a bulky solid uterine lesion in the broad ligament, mimicking ovarian malignancy. Pelvic US may show heterogenicity and multiple polypoid projections, whereas on MRI, the mass is shown as hypointense to the adjacent myometrium on T1‐weighted scans and hyperintense on T1‐weighted images 32 . In this context, because of the common features shared with CDL, the differential diagnosis is challenging and invariably obtained by the histopathologic study.…”