Two Unusual Clinical Presentations of Broad-Ligament Leiomyomas: A Report of Two Cases

Yildiz, Pınar Özmen; Cengiz, Hüseyin; Yıldız, Gazi; Şam, Aslı Demir; Yavuzcan, Ali; Çelikbaş, Bilal; Şahin, Levent

doi:10.3390/medicina48030023

Cited by 9 publications

(12 citation statements)

References 4 publications

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“…Pathology of the broad ligament is rare and the prevalence of broad ligament leiomyoma is <1 % [1]. Leiomyomas (fibroids) are benign tumors of the uterus affecting 30 % of women of reproductive age and its prevalence declines after the menopause [2].…”

Section: Introductionmentioning

confidence: 99%

A postmenopausal woman with sciatica from broad ligament leiomyoma: a case report

Tsai

2016

J Med Case Reports

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BackgroundUnilateral lower abdominal pain and/or sciatic nerve pain is a common presentation in the elderly population. The prevalence of broad ligament leiomyoma is <1 % with the prevalence declining after the menopause and it is rare for broad ligament leiomyomas to be clinically significant. Thus, we highlight a case of symptomatic broad ligament leiomyoma in a postmenopausal woman whose symptoms improved after definitive treatment.Case presentationA 62-year-old postmenopausal Macedonian woman was referred to our gynecological department with unexplained pain in her left leg and left iliac fossa region on walking. There was minimal relief with increasing analgesia use prescribed by the family physician. Investigations revealed an ipsilateral adnexal mass and subsequent treatment with laparoscopic broad ligament myomectomy helped to alleviate her symptoms.ConclusionsOur case highlights the importance of staying mindful of alternate diagnoses when presented with a common presentation of iliac fossa pain and pain in the leg. Although broad ligament leiomyomas are benign tumors, the uncommon symptomatic presentation led us to report and focus some attention on this type of tumor.

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Section: Introductionmentioning

confidence: 99%

A postmenopausal woman with sciatica from broad ligament leiomyoma: a case report

Tsai

2016

J Med Case Reports

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“…Patient's age and menopausal status are important factors to consider when identifying an adnexal abnormality, as the associated risk of malignancy increases from 13% in premenopausal women to 45% in postmenopausal women. 1 In case of broad ligament myoma preoperative diagnosis may be missed, even on MRI & diagnosis clinched only intraoperatively. Seniority of the reporting radiologist & route of ultrasonography may not improve the detection of broad ligament fibroid.…”

Section: Discussionmentioning

confidence: 99%

Broad ligament myoma at 75 causing clinical, ultrasonic and intraoperative diagnostic dilemma

Gadre

2014

Int J Reprod Contracept Obstet Gynecol

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Incidence of broad ligament fibroid is <1%. 1 Broad ligament myomas are known to cause diagnostic difficulties, clinically & on imaging as well. They pose a challenge at preoperative imaging. 2 They may also prove to be a surgical challenge. The case is reported for its rarity, and the diagnostic dilemma it caused intraoperatively as well. CASE REPORT This is a report of a 75 years patient with pain in upper abdomen since one & half years. No history of menstrual problems or any other complains. She had a USG report done one year back elsewhere suggestive of neoplastic mass in right adnexa. No other details of the report neither the film was available. General examination & per abdomen examination-WNL P/V-uterus R/V, atrophic; right adnexa having a nontender mass of 4 cms diameter, firm, mobile, separate from uterus. All routine investigations WNL & CA 125 levels 19.7 U/L. USG-Uterus 5.4 cm x 2.6 cms, endometrium thin line, well defined rounded to oval, hypoechoeic mass lesion of 3.8 cms x 3.9 cms x 3.1 cms noted in rt adnexa showing soft tissue consistency. Right ovary not seen separately. Left ovary measured 1.6 x 1.3 cms. Preoperative diagnosis: Persistent postmenopausal ovarian mass on right side.

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“…Various standards can be applied to adnexal masses that are suspected to be broad ligament fibroids, such as size, vascularity and anatomical relationship to the uterine arteries or other pelvic sidewall structures. Ultimately though, the rarity of broad ligament fibroids, and the potential for misdiagnosis as ovarian or retroperitoneal tumours [4][5][6], makes the development of standardised ultrasound criteria extremely difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Appearing adnexal in location, they may be confused with ovarian tumours [4,5] or may have an alternative histological diagnosis following myomectomy; a suspected broad ligament fibroid was reported as a pelvic schwannoma at histology [6].…”

Section: Introductionmentioning

confidence: 99%

Broad ligament fibroids—a radiological and surgical challenge

2014

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Currently, there is limited data on the ease of imaging of broad ligament fibroids and their safe laparoscopic management. We aimed to review all laparoscopic myomectomies over an 8-year period, focusing on intraoperative findings and corresponding pre-operative imaging. All laparoscopic myomectomies performed between 2004 and 2012 were reviewed. Cases with broad ligament fibroids were identified. Presenting symptoms, imaging, intraoperative findings, complications and 6-month follow-up were noted. Ten broad ligament fibroids were identified from 185 cases of laparoscopic myomectomies. Mean broad ligament fibroid diameter was 8.1 cm, and the largest was 15 cm. Mean combined fibroid weight was 267 g (range 30-560 g). Blood loss was associated with the total number of fibroids excised rather than the diameter of the broad ligament fibroid (range 30-400 ml). Accurate pre-operative diagnosis at imaging was made in only one of the ten broad ligament fibroids. Of the remainder, one was thought to be an ovarian mass, one fibroid was missed entirely and seven were reported non-specifically as 'lateral'. This case series indicates the challenge posed by broad ligament fibroids at pre-operative imaging. Underreporting may reflect a lack of awareness of the surgical significance of broad ligament fibroids. There should be a high level of suspicion for location within the broad ligament if a fibroid reported is as lateral. With adequate operator experience, large fibroid size should not contraindicate laparoscopic management of broad ligament fibroids.

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Two Unusual Clinical Presentations of Broad-Ligament Leiomyomas: A Report of Two Cases

Cited by 9 publications

References 4 publications

A postmenopausal woman with sciatica from broad ligament leiomyoma: a case report

A postmenopausal woman with sciatica from broad ligament leiomyoma: a case report

Broad ligament myoma at 75 causing clinical, ultrasonic and intraoperative diagnostic dilemma

Broad ligament fibroids—a radiological and surgical challenge

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