Post-hysterectomy leiomyoma: an everlasting enigma

Broad ligament leiomyomas are rare extra-uterine smooth muscle tumours that may present a diagnostic challenge, particularly in patients with a prior hysterectomy where they may closely mimic malignancy. We report a case of a woman in her early 60s, with a history of laparotomy and hysterectomy, who presented with abdominal pain and a pelvic mass detected on imaging. Intraoperatively, a large, solid, cystic pelvic mass was identified, adherent to the adjacent pelvic structures and deriving vascular support from the surrounding tissues. The mass was excised and sent for histopathological examination which confirmed the diagnosis of leiomyoma. This case emphasises that, despite their rarity, broad ligament leiomyomas should be considered as a potential cause of pelvic masses in post-hysterectomy patients. Accurate diagnosis requires careful clinicoradiological correlation and intraoperative assessment to prevent misdiagnosing as malignancy, with histopathological examination remaining the gold standard for diagnostic confirmation.