DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162145

Unusual case of intraperitoneal round ligament fibroid, mimicking ovarian carcinoma

Ramneet Kaur, Alka Patankar

Abstract


Round ligament leiomyoma are extremely rare benign tumors. It may present with wide range of clinical presentations depending on its site of origin, on the long course of round ligament. It has been reported round ligament leiomyoma commonly arises from extra peritoneal end of round ligament. There have been case reports where round ligament fibroid have presented like incarcerated inguinal hernia, vulvar swelling, inguinal lymph node. We present a case of intraperitoneal round ligament leiomyoma. A 40 year old female presented to gynecology Opd with a pain abdomen, abdominal distension and a mass of 26-28 weeks size gravid uterus, pelvic in origin. Her CA-125 level was 185 U/ml, CT abdomen suggested neoplastic ovarian tumor. With provisional diagnosis of ovarian carcinoma, patient was taken for exploratory laparotomy. Intraoperative findings suggested mass arising from intraperitoneal part of round ligament, with solid and cystic component and ascites. Bilateral ovaries and tubes were healthy and separately seen from mass. Histopathology report confirmed leiomyoma with hyaline and cystic degeneration. Large round ligament leiomyoma with degenerative changes can mimic ovarian carcinoma on imaging. A tissue biopsy or MRI before surgery can be of help.

Keywords


CA- 125, Leiomyoma, Ovarian carcinoma, Round liagament

Full Text:

PDF

References


Fasih N, Shanbhogue AKP, Macdonald DB, Fraser-Hill MA, Papadatos D, Kielar AZ, et al. Leiomyomas beyond the uterus: unusual locations, rare manifestations. Radiographics. 2008;28(7):1931-48.

Rock JA, Jones HW, Te- Linde’s. Operative Gynecology. 10th edition. Philadelphia, PA,USA. Lippincott Williams and Wilkins; 2008:91.

Williams PL, Bannister LH, Berry MM, Collins P, Stain M, Dussek JE, et al. Editors. Grey’s Anatomy. 38th ed. New York: Churchill Livingston; 1995:1874.

Alexander L, Maria GHA, Christian K, Gerhard B, Johann L. Leiomyoma of the round ligament in a post-menopausal woman. Maturitas. 1999;31:133-5.

Ali SM, Malik KA, Al-Qadhi H, Shafiq M. Leiomyoma of the round ligament of the uterus. Sultan Qaboos Univ Med J. 2012;12(3):357-9.

Mettingly RF, Woodruff JO. Surgical conditions of the vulva. Rock JA, Jones HW eds in: Te Linde's Operative Gynecology. 10th edition. Philadelphia, Pa, USA: Lippincott W and W; 2008:487-500.

David MW, Stanley RM. Leiomyoma of extra-peritoneal round ligament: CT demonstration. Clin Imaging. 1999;23:375-6.

Hoffman BL, Schroge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham FG. William’s Gynecology. 2nd edition. Texas: McGraw hill; 2012:247-252.

Ishikawa H, Ishi K, Serena VA, Kakazu R, Bulun SE, Kurita T. Progestrone is essential for maintenance and growth of uterine leiomyomata. Endocrinology. 2010;151(6):2433.

Smith P, Heimer G, Norgren A, Ulmsten U. The round ligament: a target organ for steroid hormones. Gynecol Endocrinol. 1993;7:97-100.

Birge O, Arslan D, Kinali E, Berk B. Round ligament of uterus leiomyoma: an unusual cause of dyspareunia. Case Reports in Obstetrics and Gynecology. 2015;2015:Article ID 197842.

Renter´ıa-Ruiz NP, de Wit-Carter G, Villaseñor-Diez J, Flores-Estrada JJ, Rodríguez-Reyes AA. Mesectodermal leiomyoma. Unusual tumor of the ciliary body. Cirugia y Cirujanos. 2014;82(1):70-5.

Harish E, Sowmya N, Indudhara P. A rare case of round ligament leiomyoma: an inguinal mass. Journal of Clinical and Diagnostic Research. 2014;8(10):5-6.

Nakamura Y, Hata Y, Koezuka S, Makino T, Otsuka H, Sato F, et al. Tracheal leiomyoma resected with endobronchial electrocautery snare. Journal of Bronchology and Interventional Pulmonology. 2015;22(1):90-3.

Low SC, Chong CL. A case of cystic leiomyoma mimicking an ovarian malignancy. Ann Acad Med Singapore. 2004;33:371-4.

Brown RS, Marley JL, Cassoni AM. Pseudo-Meigs’ syndrome due to broad ligament leiomyoma: a mimic of metastatic ovarian carcinoma. Clin Oncol (R Coll Radiol). 1998;10(3):198-201.

Hoffman BL, Schroge JO, Schaffer JI, Halvorson LM, Bradshaw KD, Cunningham FG. Epithelial ovarian cancer in William’s Gynecology. 2nd Edition. Texas: McGraw hill; 2012:860.