Is It an Ovarian Tumor or Broad Ligament Leiomyoma?

Uterine leiomyomas, also known as myomas or fibroids, are by far the commonest benign uterine tumors. Leiomyomas are not uncommon in the round, ovarian and broad ligaments. They can be misdiagnosed as ovarian tumor even by MRI that can give typical findings of ovarian neoplasm, thereby altering the course of treatment offered. A menopaused 53 years old lady, biparous, presented to our clinic for regular check-up. She is previously healthy and denies any complain. She has however a family history of ovarian cancer. General physical examination was unremarkable. The vagina and cervix appeared healthy on gross visualization without any discharge or vaginal bleed. Ultrasonography of pelvis revealed a well-defined heterogeneous right adnexal mass of 4.3x 3.26 cm. MRI showed a 38x39 mm isointense in both T1 and T2 right adnexal mass with an impression of fibro-thecoma. Serum Ca -125 (cancer antigen) 31 U\mL. The family history as well as the aspect of the mass on ultrasound and MRI raised the suspicion of an ovarian tumor. However, Laparoscopy revealed a mass arising from the right broad ligament whose Histopathological examination confirmed a broad ligament leiomyoma that was removed laparoscopically. Laparoscopic approach for broad ligament fibroid can achieve good results. Till present, there is very few data on the ease of imaging of broad ligament leiomyoma as it would not help ruling out the origin of adnexal mass accurately.