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Dr. Poonam Khera

Dr. Poonam Khera
Sr. Consultant
Obstetrics and Gynaecology
BLK Super Speciality
Hospital, New Delhi



Dr. Laxmi Mantri

Dr. Laxmi Mantri
Sr. Consultant Obstetrics and Gynaecology BLK Super Speciality Hospital, New Delhi

Dr. Niti Chaturvedi

Dr. Niti Chaturvedi
Associate Consultant
Obstetrics and Gynaecology BLK Super Speciality
Hospital, New Delhi

An Extraordinary Case

Treating a woman with rarest reported Broad
Ligament Fibroid

Fibroid or Leiomyomas are the most common pelvic Tumours present in 20% of women in the reproductive age. These are composed of smooth muscle with a variable amount of fibrous connective tissues. They may be uterine or extra uterine in origin. Extra uterine fibroids are rare and may arise in broad ligament or at other side where smooth muscle exist. Broad Ligament Fibroid are mostly epithelial in nature, whereas Mesenchymal Tumours of the broad ligament are Leiomyomas. They may cause variety of symptoms such as menstrual irregularities and pressure effects. The case at hand is that of a 54-year old patient with true Broad Ligament Fibroid which is quite rare and has been the largest reported till date.

THE CASE

A 54-year old post-menopausal patient was brought to BLK with complaints of increasing abdominal distension and pain for a year and a half. The mass in her abdomen was gradually increasing in size for about the same time. There was no history of bleeding, fever or bowel or bladder complaint.

Abdominal examination revealed a mass of 36 week size arising from the pelvis with regular margins, firm in consistency and was nontender. The patient looked like someone with a full term pregnancy.

Ultrasound of the abdomen showed the large well circumscribed mass lesion of approx. 29x26x2 cm in the abdominopelvic region which was superiorly extending up to the epigastrium and was inseparable from the uterus.





THE PROCEDURE

The patient was taken up for total abdominal Hysterectomy and intraoperatively a true Broad Ligament Fibroid mass of approx. 32x30x16 cm and 10 kg weight was detected in the abdominal cavity. The bladder was advanced which was separated and Broad Ligament Fibroid mass was dissected out and separated from the uterus with capsule intact. Uterus was menopausal size, the left tube and ovary was normal and atrophic. Right tube and ovary were adherent. TAH with LSO was done in a usual manner and specimen was sent for HPE leaving behind the right tube and ovary. Bilateral ureters were traced and normal peristalsis of both ureters were seen with adequate urine output.

THE RESULT

With timely diagnosis and management of pressure symptoms like hydroureter, hydronephrosis and rectal symptoms were avoided. The post-operative period was uneventful and the patient was able to lead a normal healthy life.

DISCUSSION

Although extra uterine fibroids are rare and histologically benign, they may mimic Malignant Tumours clinically and on imaging may present a diagnostic challenge. The symptoms and imaging feature depend on the location and size of lesion. During surgery, one should be very careful about the ureteric course and surrounding organs.


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