Broad ligament leiomyoma
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Broad ligament leiomyomas are also referred to 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, maybe as a result of pressure effects on adjacent organs, such as the bladder or ureter; or, when acute, due to a complicating torsion.
These extra-uterine leiomyomas arise 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 that 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 tumor 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 tumors
- neurofibroma in the pelvis