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Broad ligament leiomyoma

A broad ligament leiomyoma is a leiomyoma that occurs in relation to the broad ligament and is sometimes considered as variation in terms of location for a uterine leiomyoma.

Clinical presentation

While in most cases broad ligament leiomyomas are asymptomatic, patients may present pelvic pain or a palpable pelvic/ abdominal mass. Pelvic pain may be as result of pressure effects on adjacent organs or a complicating torsion.

Pathology

It is type of extra-uterine leiomyoma and arise from the broad ligament (often by a stalk).

Radiographic features

General 

A leiomyoma occurring in this location poses greater diagnostic difficulty than when it occur in the uterus. In uncomplicated cases (e.g no degeneration) it is seen as a solid adnexal mass which is separate from both the uterine body as well as the ovary.

Pelvic ultrasound

Usually seen as an hypo-echoic, solid, well-circumscribed adnexal mass, although that can be heterogeneous when large. There is generally no interface between tumour and uterus and no straight relation to the ipsilateral ovary

Pelvic MRI

Signal characteristics in uncomplicated cases are essentially similar to a uterine leiomyoma

  • T1 : iso to low signal
  • T2 : typically low signal
  • C+ (Gd) : most enhance similarly to the myometrium, while larger leiomyomas tend to enhance less and heterogeneously

Complications

Torsion of the leiomyoma can occur is pedunculated

Differential diagnosis

General considerations include

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