|Year : 2012 | Volume
| Issue : 3 | Page : 144-146
Rare case of giant broad ligament fibroid with myxoid degeneration
RR Godbole, KS Lakshmi, Kabbur Vasant
Department of Obstetrics and Gynaecology, Belgaum Institute of Medical Sciences, Belgaum, India
|Date of Web Publication||11-Jan-2013|
K S Lakshmi
Department of Obstetrics and Gynaecology, Belgaum Institute of Medical Sciences, Belgaum - 590 001
Source of Support: None, Conflict of Interest: None
Giant fibroids are known to arise from the uterus, although very rarely from extra-uterine sites. Among extra-uterine fibroids, broad ligament fibroids generally achieve enormous size and generally present with pressure symptom like bladder and bowel dysfunction. Myxoid degeneration is a rare complication of benign fibroid, where presence of cystic changes mimics the metastatic malignant ovarian tumor. We report a case of true broad ligament fibroid measured about 13 kg. This case is reported for its rarity and the diagnostic difficulties in differentiating malignant ovarian tumor and benign fibroid with myxoid degeneration.
Keywords: Broad ligament fibroid, giant fibroid, myxoid degeneration
|How to cite this article:|
Godbole R R, Lakshmi K S, Vasant K. Rare case of giant broad ligament fibroid with myxoid degeneration. J Sci Soc 2012;39:144-6
| Introduction|| |
Fibroids are the most common benign tumors of the female genital tract. Extra-uterine fibroid is not common as uterine fibroids. It may arise in the broad ligament or at other sites where smooth muscle exists.  The real incidence of broad ligament fibroid is not known. Most common presentation of fibroid is menstrual disturbances and reproductive dysfunction. However, broad ligament fibroids generally present with pressure symptom like bladder and bowel dysfunction. Most common secondary changes in fibroids are degenerations, infections, hemorrhage, and necrosis. Myxoid degeneration is a rare complication of benign fibroid, where presence of cystic changes mimics the metastatic malignant ovarian tumor.
| Case Report|| |
A 40-year-old P3L3 perimenopausal woman came to Department of Obstetrics and Gynaecology, Civil Hospital, a teaching hospital attached to Belgaum Institute of Medical Sciences, Belgaum, with complaints of pain in abdomen and mass per abdomen since 6 months. It was gradual in onset and progressive in nature. Patient gave history of rapid increase in size since 2 months and no history of weight loss/anorexia/fever. Her menstrual cycle was regular and normal and no history of malignancy in family members.
A 40-year-old woman of moderate build and nutrition with pallor, no lymphadenopathy was presented. On examination, blood pressure was 110/70 mmHg, pulse rate 84 bpm, and respiratory rate 16 bpm. Cardiovascular and respiratory systemic examination was normal. Per abdominal examination revealed a uniform, firm, smooth surface, regular, and non-tender mass of 32-week size, which appeared to be arising from pelvis. Lower pole could not be reached and shifting dullness could be elicited. On per speculum examination, cervix was deviated to right side with minimal cystocele and rectocele. On per vaginal examination, uterus could not be felt separately. Fornix fullness was present. Per rectal examination was normal.
The hemoglobin level was 12.4 g%, blood urea was 27.4 mg/dL, serum creatinine was 0.8 mg/dL, random blood sugar was 106 mg/dL, serum sodium was 138 meq/L, serum potassium was 4.3 meq/L, and serum chloride was 100 meq/L. Urine culture and sensitivity findings showed no growth. Total count and differential count were normal. CA-125 levels were within normal limits.
Transabdominal sonography revealed huge complex solid cystic mass arising from the pelvis and extending into the abdomen occupying almost whole of the abdomen suggestive of ovarian mass and cholilithiasis.
The computed tomography of abdomen plain and contrast showed large heterogeneously enhancing predominantly solid lesion with cystic component occupying almost entire lower abdomen and pelvis. It also revealed bilateral mild hydroureteronephrosis and cholilithiasis. Impression was probably malignant ovarian tumor.
As in our case, diagnostic reports were inconclusive, and with high suspicion of ovarian malignancy due its size, exploratory laparotomy was decided. Patient underwent excision of broad ligament tumor along with panhysterectomy.
| Intraoperative Findings|| |
Around 500 cc of amber colored ascitic fluid was drained. A big mass adherent to sigmoid colon of size 16 × 35 × 50 cm occupying whole pelvis and abdomen weighing around 15 kg. Mass was enucleated within pseudocapsule. Uterus pushed to left side and posteriorly. Both tubes and ovaries appeared healthy. As a huge tumor was distorting the pelvic anatomy, careful dissection was done to prevent ureteric injuries [Figure 1]. It was true broad ligament fibroid. Cut section of tumor showed multiple cystic areas.
On gross examination, single large globular soft tissue mass measuring 16 × 35 × 50 cm, weighing 13 kg. Cut section showed mucoid and cystic areas [Figure 2]. Microscopic examination showed leiomyoma with myxoid change. Histopathology of uterus with cervix, bilateral Fallopian tube More Detailss, and ovaries were unremarkable. Ascitic fluid cytology showed no evidence of malignancy.
Postoperative period was uneventful and patient was discharged on postoperative day nine.
| Discussion|| |
Uterine fibroids, also known as myomas or leiomyomas, are the commonest of all pelvic tumors, being present in 20% of women in the reproductive age group and increasing with age. They are usually diagnosed on physical examination or with pelvic imaging.  Fibroids are not uncommon in the round, ovarian, and broad ligaments, they are found in association with similar uterine tumors, and their pathology and complications are the same as fibroids. Fibroids in the broad ligament though not so common, but are well known for achieving enormous size, which may mimic a malignancy of the pelvis. Broad ligament fibroids are of two types: false broad ligament fibroid (uterine tumor which grows into the broad ligament) and a true broad ligament fibroid arising from the subperitoneal connective tissue of the ligament.  This case reports true broad ligament fibroid where the patient presented with a mass per abdomen that seem to be arising out of the pelvis had features of malignancy both clinically and radiologically, and histopathology confirmed it as a benign broad ligament fibroid. A similar case reports ,, have also been reported for its rarity, and the diagnostic difficulties it posed. In our case, we did not find operative difficulties because tumor was enucleated within pseudocapsule and dissection was easy. Degenerative changes in the leiomyomas are considered due to inadequate blood supply. Myxoid and calcific degenerations are the commonest form of degeneration seen in broad ligament fibroid. The fibroid in our report had undergone myxoid degeneration. Others have reported broad ligament fibroid with calcific degeneration. 
The broad ligament benign tumor even though being uncommon can grow to a large size as epitomized in this case. Degenerative changes such as myxomatous degeneration occur even in broad ligament fibroid causing error in final diagnosis. Their removal can be difficult and hazardous chiefly because of the risk to the ureter.
| Acknowledgment|| |
The authors are thankful to Medical Director, Belgaum Institute of Medical Sciences, Belgaum for permitting to publish this case report. Also we would like to thank all the staff members of Department of Obstetrics and Gynaecology, Belgaum Institute of Medical Sciences, Belgaum and patient for their co-operation.
| References|| |
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[Figure 1], [Figure 2]