Broad ligament leiomyomas are also referred as a type of parasitic leiomyomas 5.
While in most cases broad ligament leiomyomas are asymptomatic, patients may present pelvic pain or a palpable pelvic mass. The pain, when long-standing, may be as a result of pressure effects on adjacent organs, such as the bladder or ureter; or, when acute, due to a complicating torsion.
It is a type of extra-uterine leiomyoma that arises from the smooth muscle elements of the broad ligament 5.
A leiomyoma occurring in this location poses greater diagnostic difficulty than when it occurs 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.
Usually seen as a hypoechoic, solid, well-circumscribed adnexal mass, although that can be heterogeneous when large. There is generally no interface between the tumour and uterus and no straight relation to the ipsilateral ovary.
Signal characteristics in uncomplicated cases are similar to those exhibited by uterine leiomyomas:
- T1: iso to low signal
- T2: typically low signal
- T1 C+: most enhance similarly to the myometrium while larger leiomyomas tend to enhance less and heterogeneously
Treatment and prognosis
Torsion of the leiomyoma can occur if pedunculated.
General considerations include:
- other unusual leiomyomas
- solid ovarian neoplasms: particularly those with dominant fibrous components
- other ligamentous mesenchymal tumours
- neurofibroma in the pelvis
- 1. Gowri V, Sudheendra R, Oumachigui A et-al. Giant broad ligament leiomyoma. Int J Gynaecol Obstet. 1992;37 (3): 207-10. - Pubmed citation
- 2. Spencer JA, Ghattamaneni S. MR imaging of the sonographically indeterminate adnexal mass. Radiology. 2010;256 (3): 677-94. doi:10.1148/radiol.10090397 - Pubmed citation
- 3. Pelsang RE, Sorosky J, Woods T. Sonographic evaluation of a leiomyoma of the broad ligament of the uterus. J Clin Ultrasound. 1999;27 (7): 402-4. J Clin Ultrasound (link) - Pubmed citation
- 4. Eurorad teaching files : Case 7530
- 5. Fasih N, Prasad Shanbhogue AK, Macdonald DB, Fraser-Hill MA, Papadatos D, Kielar AZ, Doherty GP, Walsh C, McInnes M, Atri M. Leiomyomas beyond the uterus: unusual locations, rare manifestations. (2008) Radiographics : a review publication of the Radiological Society of North America, Inc. 28 (7): 1931-48. doi:10.1148/rg.287085095 - Pubmed