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CLINICAL IMAGE
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 47-48

A rare case of utero-ovarian ligamental leiomyoma


Department of Gynaec Endoscopy, Womens Hospital, Mumbai, Maharashtra, India

Date of Submission09-Oct-2018
Date of Decision07-Dec-2018
Date of Acceptance10-Dec-2018
Date of Web Publication23-Jan-2020

Correspondence Address:
Dr. Sharda Arvind
Womens Hospital, Plot No 674, 16th Cross Road, Behind Khar Gymkhana, Khar West, Mumbai - 400 052, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_100_18

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How to cite this article:
Rao G, Arvind S, Raje S, Chawla LJ. A rare case of utero-ovarian ligamental leiomyoma. Gynecol Minim Invasive Ther 2020;9:47-8

How to cite this URL:
Rao G, Arvind S, Raje S, Chawla LJ. A rare case of utero-ovarian ligamental leiomyoma. Gynecol Minim Invasive Ther [serial online] 2020 [cited 2020 Apr 6];9:47-8. Available from: http://www.e-gmit.com/text.asp?2020/9/1/47/276493



Extrauterine leiomyomas are rare benign tumors originating from smooth muscle cells. They can originate from broad ligament, round ligament, utero-ovarian ligament, or any tissue containing smooth muscle fibers.[1]

Utero-ovarian ligament and round ligament are remnants of the gubernaculum containing smooth muscle fibers and connective tissue. Utero-ovarian ligamental leiomyomas are extremely rare and their exact incidence is not known.

Although they are histologically benign tumors, they can mimic ovarian tumors and pose a diagnostic challenge. Due to close proximity, a utero-ovarian ligamental leiomyoma can mimic the ovarian or adnexal pathology. A thorough preoperative evaluation to rule out the ovarian pathology should always be done. As this patient is in reproductive age group, preoperative provisional diagnosis was important to decide the route and type of surgery.

To the best of our knowledge, there are only two reported cases of utero-ovarian leiomyoma in the published english literature.[2],[3]

A 34-year-old, nulligravida woman presented with the complaints of pain in the left iliac region. She had regular menstrual cycles. Clinical examination revealed a firm, globular pelvic mass extending above the pubic symphysis.

A transvaginal ultrasound was suggestive of large fibroid 14 cm × 11 cm × 13 cm, in midline with significant cystic degeneration. Uterus was normal and observed separately [Figure 1].
Figure 1: Ultrasound image

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Magnetic resonance imaging (MRI) was suggestive of a large adenexal mass most likely degenerative broad ligament fibroid. Tumor markers were done to rule out ovarian pathology. MRI and serum lactate dehydrogenase levels were suggestive of degenerative broad ligament fibroid. Patient was counselled regarding the rare possibility of maliganancy.

As the pathology was large, multiport laparoscopy was performed (10-mm supraumbilical optical port, three accessory 5-mm ports, two left lateral, and one right lateral). Pneumoperitoneum is created by inserting a Veress needle at palmer's point. After the creation of pneumoperitoneum, the first 5-mm blind trocar is inserted in the left upper lumbar zone, which is later used as an accessory port. All other ports are then inserted under the vision. Left lower port is later converted to 15-mm morcellation port (contained tissue extraction).

On laparoscopy a solid, globular large left adenexal mass with smooth surface was observed arising from the left utero-ovarian ligament. The mass observed was attached to the omentum deriving its auxillary blood supply. Uterus, both  Fallopian tube More Detailss and ovaries appeared grossly normal [Figure 2] and [Figure 3].
Figure 2: Left utero-ovarian ligamental mass

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Figure 3: Utero-ovarian ligament

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Laparoscopic excision of the left adenexal mass followed by contained tissue extraction was done. Retrieval of the specimen in principle was done by contained tissue extraction using power morcellation. Specimen weighing 632 g was retreived [Figure 4].
Figure 4: Postexcision image

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Histological diagnosis was leiomyoma showing hyalinization and areas of infarction.

The patient had uneventful postoperative recovery.

Ethical statement

This study was approved by institutional ethical committee of Womens Hospital (approval no. 0778/2018 obtained on October 6th, 2019) and informed consent was obtained from patient participants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar P, Malhotra N. Tumors of the corpus uteri. Jeffcoate's Principles of Gynaecology. 7th ed. New Delhi: Jaypee Brothers; 2008. p. 492, 523-41.  Back to cited text no. 1
    
2.
Yoldemir T, Atasayan K, Eraslan A. A giant extra-uterine fibroma originating from an utero-ovarian ligament initially diagnosed as an ovarian tumour. Marmara Med J 2014;27(2).  Back to cited text no. 2
    
3.
Valvi D, Parulekar SV. Uteroovarian ligament leiomyoma. JPGO 2015;3(1).  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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