Huge broad ligament leiomyoma with cystic degeneration: A diagnostic and surgical challenge

Broad ligament is the common extrauterine site for fibroid. We present a case of huge broad ligament fibroid with cystic degeneration. Patient presented with abdominal swelling and mild pain abdomen. On abdominal examination, a large tense cystic mass of 34 weeks gravid uterus size arising from pelvis was noted. Cervix was pulled up and all fornices were full with mass on pelvic examination. Ultrasound suggested adnexal mass as ovaries were not seen. Contrast-enhanced computed tomography abdomen too reported adnexal mass likely of ovarian origin. On laparotomy, 6 L of straw color fluid drained from the mass which was seen arising from left broad ligament, bilateral ovaries were separate from the mass and appeared healthy. Enucleation of mass was done to ease the hysterectomy and careful evaluation of ureteric course was done throughout the surgery to avoid its injury. Total hysterectomy with bilateral salpingo-opherectomy and pelvic lymphadenectomy was performed. This case is being reported for its rare incidence, diagnostic dilemma and surgical challenge.