Title: Broad ligament leiomyoma, 11.5Kg. 40Cm.

Type of article: Case Report

Author: Galal Lotfi. MD, MRCOG, Obstetrics and
Gynecology department, Suez Canal University, Egypt.
Correspondence:
Professor Galal Lotfi, MD, MRCOG.
Obstetrics and Gynecology department.
Suez Canal University, Egypt.
Mailing Address:
14A Sherif Street
Roxy, Heliopolis, Cairo, Egypt.
Tel: #202- 24535597
Email: G.lotfi@icloud.com
glotfi@gmaol.com
Abstract:
33 year old mother of two children, presented herself with
multiple myomata reaching the xiphisternum with a main
complaint of pressure symptoms and difficult breathing.
She had a pfannenstiel scar for her two cesarean
sections; last one was two years earlier. Laparotomy
through pfannenstiel incision and muscle cutting was
carried out. There was a 40x 40cm cauliflower broad
ligament fibroid with the uterus just sitting on it. Successful
myomectomy was carried out.
Keywords: Leiomyoma, Broad ligament, Myomectomy
Introduction

Leiomyoma is the most common tumor of the uterus and

the most common benign tumor of the female genital tract.
Leiomyomas affect 30% of all women of reproductive age
(1,2). Broad ligament Leiomyoma is only 1% of
Leiomyomas and although it is a different anatomical entity
it is affiliated to uterine leiomyomas. It is usually
asymptomatic and for that reason could reach up to any
size. Symptoms is the exception and not the rule.
Leiomyoma is the most common solid tumor of the broad
ligament(3), but the incidence is < 1% of all uterine
myomatas.
Leiomyomas can arise from any tissue, such as the
uterus, that contains smooth muscle cells that can invade
the broad ligament; leiomyomas can also originate from
the broad ligament itself.
Case.
A 33-year old patient with previous two cesarean sections
presented herself with already known fibroid uterus. She
had her last cesarean section delivery 2 years earlier. As
a matter of fact she was told during the antenatal visits
that she is having a fibroid that could be taken care of
during the section. After the operation she was told that it
was away from the uterus and was left intact.
On examination I thought that she is pregnant, full term
oversized pregnancy. That what thought; assuming that I
am palpating the big uterus enroaching and pushing on

the xiphisternum and filling the whole abdomen. All

imaging investigations (US, CT, MRI} reported big fibroid
and nothing else.
The patient main concern was her huge abdomen size
and pressure symptoms. She was counseled for
laparotomy and her main request was not to have a
hysterectomy in any circumstances.
Pfannenstiel incision was carried out and the abdomen
was explored to find the uterus as small and normal in size
and shape but sitting on huge fibroid mass filling the pelvis
and abdomen. I did not see such a huge broad ligament
cauliflower fibroid before. It was attached to the uterus.
The broad ligament was opened and meticulous
enucleation and dissection was carried out. Step by step
we could take it out of the abdomen with the help of one
blade of obstetric forceps. The left over dead space was
closed by approximating the broad ligamed leafs.The
uterus and ovaries were left intact. Postoperative period
passed uneventful and pathological report confirmed the
diagnosis: 40cm cauliflower leiomyoma, 11.5Kg in weight.
Discussion
Leiomyoma of broad ligament are either with an
attachment to the uterus that is to say primarily originate in
the uterus and grow outwards between the broad ligament

leafs or arise primarily from the broad ligament itself

without actual attachment to the uterus.
Myomectomy in that case was done by opening the
borage ligament and dissecting the myoma out. If you
stick to a proper cleavage line you will be safe from
injuring major vessels like the uterine or the ureters that
could be easily identified and avoided.
After removing the myoma the dead space could be
nullified by approximating the leafs of the broad ligament.
Any patients request could be respected. In that patient
hysterectomy would not do any benefit either for the
course of surgery or for the patient future.
Conclusion:
Borage ligament Leiomyoma could be of any size.
Hysterectomy is not always the best option for dealing with
Leiomyoma. Patient request regarding the type of surgery
could be respected.

Fig 1. The uterus is riding on the broad ligament myoma,

tube and ovary overstretched.

Fig 2. That is still only half of the myoma, the rest was still
in the pelvis.

Fig 3, It shows that the normal sized uterus was free of

myomata.

Fig 4, Same exposure as Fig 3.

Fig 5. Now the rest of the myoma was exteriorized after

opening the broad ligament.

Fig 6, The whole myoma was enucleated but still attached

to the uterus.

Fig 7, Completing the dissection.

Fig 8, The wholw mass is out, 11.5Kg

References
(1) Baird DD, Dunson DB, Hill MC, Cousins
D, Schectman JM. High cumulative
incidence of uterine leiomyoma in black
and white women: ultrasound evidence.
Am J Obstet Gynecol 2003;188:100-7.
(2) Marshall LM, Spiegelman D, Barbieri
RL, et al. Variation in the incidence of
uterine leiomyoma among premenopausal
women by age and race. Obstet Gynecol
1997;90:967-73.
(3)Prker WHUterine myomas: an overview of
development, clinical features, and managementObstet
Gynecol, Volume 105, 2005, pp. 216217.