Primary broad ligament fibroid: a case report with review of the literature

Abstract

Fibroids are benign tumors with minimal malignant potential arising from estrogen-sensitive smooth muscles, which can be uterine and extrauterine in origin. The broad ligament is the most common site for extrauterine fibroids, and it is differentiated into primary and secondary. A fibroid arising from smooth muscles in the broad ligament without attachment to the uterus or connected to it by a vascular pedicle is classified as a primary broad ligament fibroid. Its significance lies in the retroperitoneal location in the parametrium, which distorts the anatomy and affects the surrounding viscera, making diagnosis as well as surgical management challenging. Patient is usually asymptomatic or has vague pain abdomen and bloating unless it grows to a large size, putting pressure on the ipsilateral ureter and bladder, and an abdominal mass may be detected, pushing the uterus to the other side, and development of symptoms. Diagnosis is usually incidental during pelvic surgery for other pathology. Neither clinical nor imaging studies can differentiate it from an adnexal mass. Treatment is myomectomy by laparotomy or a minimally invasive approach. In both methods, the procedure is high risk for injury to the ipsilateral ureter and uterine vessel and blood loss due to more tissue dissection. Preoperative planning and preparation in suspicious cases, and an experienced surgeon with adequate knowledge of pelvic anatomy, is the solution to avoid complications. Our patient, a 47-year-old parous premenopausal lady, reported to this institution with dragging pain abdomen with bloating was found to have a fibroid uterus and underwent total laparoscopic hysterectomy, during which a primary broad ligament fibroid of 09×07 cm was detected incidentally, and myomectomy was done. The presentation aims to report the rare case and add to statistics, to highlight the asymptomatic nature of the tumor and the challenging diagnosis, and its management.