Tumors of the broad ligament: what and when to suspect such rare location

Abstract

Although secondary involvement of the broad ligament by malignant tumors arising elsewhere in the abdomen and pelvis is common, primary tumors in this location are rare. Tumors of the broad ligament can be of mesenchymal and mixed nature, such as leiomyoma, the most common neoplasm; epithelial tumors of Müllerian type, imposing a challenge to differentiate them from other adnexal masses; unique tumors from mesonephric origin; and tumor-like lesions. Most neoplasms in this region, whether benign or malignant, usually present clinically with vague symptoms and are often discovered during a routine gynecological examination. Suspicion of such location and knowledge of the potential range of lesions of this region may allow for planning minimally invasive surgical interventions. To be considered tumor from the broad ligament, it should not be connected with either the uterus or the ovary. Thus, the imaging approach to establish the differential diagnosis includes excluding an ovarian, uterine, or tubal origin by recognizing these separately and by rebutting imaging clues pointing to these origins. This pictorial essay reviews some of the imaging findings that may suggest such location and presents some of the possible differential diagnoses by means of illustrative confirmed cases.

Laparoscopic management of a true broad ligament leiomyoma in a patient with advanced endometriosis and a solitary kidney – A case report and literature review

“…Due to its apparent adnexal location, broad ligament myomas are often mistaken for benign or malignant ovarian masses, tubo-ovarian abscesses, broad ligament cysts, lymphadenopathy, or pedunculated uterine leiomyoma on ultrasonography [ 4 ]. Pelvic MRI is associated with superior sensitivity in assessing the precise location, number, and size of leiomyomas, their spatial relationship with other pelvic structures and the uterine topography [ 4 , 9 ]. Although pelvic MRI may improve the positive predictive value for assessing broad ligament leiomyomas, its implementation in routine clinical practice is limited by its cost and availability [ 9 ].…”

“…Pelvic MRI is associated with superior sensitivity in assessing the precise location, number, and size of leiomyomas, their spatial relationship with other pelvic structures and the uterine topography [ 4 , 9 ]. Although pelvic MRI may improve the positive predictive value for assessing broad ligament leiomyomas, its implementation in routine clinical practice is limited by its cost and availability [ 9 ]. Broad ligament leiomyomas may also produce an elevation of the tumour marker CA-125 [ 3 ].…”

Mimics and Pitfalls of Primary Ovarian Malignancy Imaging

“…In cases of masses abutting the ovary, multiple imaging signs help to assess the origin of the mass. Signs suggestive of ovarian origin include a “beak” sign, which is a sharp angle between the ovary and the mass, forming a beak shape at the edge of the ovary; the “ovarian vascular pedicle” sign, which is a depiction of a direct joining of the normal or asymmetrically enlarged gonadal vein to the mass; the “phantom organ sign”, which is an undetectable ovary provided that there is no history of surgical resection or transposition; and the “embedded organ sign”, which is when the ovary appears embedded in the mass [ 3 , 8 , 9 ]. On the other hand, there are signs suggestive of extra-ovarian origin, such as the “claw sign” and the “bridging vessel” sign, that indicate a uterine origin of the mass, which will be described in detail later, following the paraovarian cyst ( Section 5.1.5 ) and leiomyoma ( Section 5.2.2 ) sections, respectively.…”

A rare case report of a myxoid liposarcoma arising from the broad ligament

“…3 Primary tumors of the broad ligament are rare and diverse as benign (leiomyoma, epithelial tumors of Mullerian type like Paratubal/paraovarian broad ligament cysts, Wolffian tumor/ adnexal tumor, papillary cystadenoma, fibroma, endometriosis, Müllerianosis) and malignant tumors (leiomyosarcoma). 4 Broad ligament MLPS is very uncommon with only one case reported in the English literature. 5 In this report, we present a case of a primary broad ligament MLPS in a 42-year-old female and aim through a review of the literature to discuss the clinicopathological characteristics of this uncommon entity in this site.…”

“…Primary tumors of the broad ligament are rare and diverse as benign (leiomyoma, epithelial tumors of Mullerian type like Paratubal/paraovarian broad ligament cysts, Wolffian tumor/adnexal tumor, papillary cystadenoma, fibroma, endometriosis, Müllerianosis) and malignant tumors (leiomyosarcoma). 4 Broad ligament MLPS is very uncommon with only one case reported in the English literature. 5 …”