Primary Large Broad Ligament Fibroid: A Challenge in Surgical Practice

Primary broad ligament fibroids, whose surgical treatment is challenging, are extremely rare. Our case concerns the surgical treatment of a large broad ligament fibroid. A 48-year-old patient, asymptomatic and with a medical history of uterine leiomyomas, came to the gynecology outpatient clinic to undergo a routine gynecological examination. On bimanual pelvic examination, the presence of a painless palpable pelvic mass was found, without being able to clinically demarcate it. Computed tomography imaging confirmed the clinical suspicion of a pelvic mass. The pelvic mass was more consistent with the subserosal pedunculated fibroid of the uterine corpus, but the preoperative diagnosis of adnexal mass cannot be excluded. It was decided to surgical treatment of the patient with a total hysterectomy and bilateral salpingectomy-oophorectomy. Intraoperatively, the presence of a large intraligamental mass was detected. The uterus, cervix, and ovaries were normal but displaced by the tumor. After resection of the leiomyoma from the broad ligament, where it was not found to be connected to a vascular pedicle from the lateral wall of the uterine corpus or the cervix, total hysterectomy and bilateral salpingectomy-oophorectomy were performed, due to the necessary resection of the right fallopian tube and ovary and the extensive injuries in the area. The postoperative course was uneventful. In this paper, following the case presentation, a brief review of primary broad ligament fibroids is presented, emphasizing the significance of comprehensive preoperative planning in the challenging intraoperative management of these patients, who have an increased risk of intraoperative complications.