Diagnostic Dilemma: A Rare Case of Broad Ligament – Cystic Degeneration Leiomyoma
Diagnostic Dilemma: A Rare Case of Broad Ligament – Cystic Degeneration Leiomyoma
Author(s):Dr. Matam Meenakshi, Dr. L. Jayanthi Reddy, Dr. Palli Sudhir Babu
Received: June 12, 2026
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Accepted: July 2, 2026
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Published:
July 14, 2026
Abstract
Introduction: Leiomyomas are common uterine benign tumors of uterus and female genital tract accounting for approximate 20- 30% of cases. Leiomyomas can be intra-uterine or extra-uterine. Extra-uterine origin is rare and etiology is unclear, therefore have nonspecific presentations hence pose clinical and diagnostic challenges.
Case report: A 49 year old Mrs. Z, P2L2 came with complaints of lower abdomen pain in right iliac fossa for 2 years.
On bimanual examination – Uterus size could not be made out with right forniceal fullness with no forniceal tenderness.
Ultrasound abdomen and pelvis - revealed single lobulated hypoechoic lesion in the right adnexa measuring 7.2 x 6.2cms s/o sub serosal fibroid.
Total abdominal hysterectomy+ Bilateral Salpingo oophorectomy was done under spinal anaesthesia. Intraoperatively we visualized multiple venous plexus on the right side of uterus as it was supplying to the fibroid but after meticulous dissection we came to know that the venous plexus are broad ligament severe cystic degeneration fibroid. As we proceed we completely delineate the degenerated cystic fibroid from its attachment without any injury to ureter. There was no distortion of the ureteric course which doesn’t need DJ stenting intra operatively. They have been removed and sent for histo pathological examination.
Histopathology report: Confirmed it as broad ligament fibroid with cystic degeneration.
Cervix – Chronic cervicitis
Uterus – Non atypical endometrial hyperplasia
Conclusion: Broad ligament fibroids mimic adnexal masses on clinical and radiological examination. High degree suspicion and to keep solid adnexal and uterine mass as differential diagnosis is must. It is recommended to have DJ stenting if needed to avoid surgical complications and one should be very careful about ureteric course and surrounding structures.
Case report: A 49 year old Mrs. Z, P2L2 came with complaints of lower abdomen pain in right iliac fossa for 2 years.
On bimanual examination – Uterus size could not be made out with right forniceal fullness with no forniceal tenderness.
Ultrasound abdomen and pelvis - revealed single lobulated hypoechoic lesion in the right adnexa measuring 7.2 x 6.2cms s/o sub serosal fibroid.
Total abdominal hysterectomy+ Bilateral Salpingo oophorectomy was done under spinal anaesthesia. Intraoperatively we visualized multiple venous plexus on the right side of uterus as it was supplying to the fibroid but after meticulous dissection we came to know that the venous plexus are broad ligament severe cystic degeneration fibroid. As we proceed we completely delineate the degenerated cystic fibroid from its attachment without any injury to ureter. There was no distortion of the ureteric course which doesn’t need DJ stenting intra operatively. They have been removed and sent for histo pathological examination.
Histopathology report: Confirmed it as broad ligament fibroid with cystic degeneration.
Cervix – Chronic cervicitis
Uterus – Non atypical endometrial hyperplasia
Conclusion: Broad ligament fibroids mimic adnexal masses on clinical and radiological examination. High degree suspicion and to keep solid adnexal and uterine mass as differential diagnosis is must. It is recommended to have DJ stenting if needed to avoid surgical complications and one should be very careful about ureteric course and surrounding structures.
Keywords: Broad ligament, DJ stenting, Leiomyoma
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