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Thanasa A, Thanasa E, Kamaretsos E, Grapsidi V, Xydias E, Ziogas A, Gerokostas EE, Antoniou IR, Paraoulakis I, Thanasas I. Surgical treatment of a very rare case of a huge intraligamental leiomyoma of the uterus: A case report and mini‑review of the literature. MEDICINE INTERNATIONAL 2024; 4:2. [PMID: 38107473 PMCID: PMC10719964 DOI: 10.3892/mi.2023.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
Intraligamental leiomyomas of the uterus are rare. Extremely rare are the huge intraligamental fibroids (>20 cm), whose pre-operative diagnosis and surgical management poses a challenge to everyday clinical practice. The present study describes the case of patient who was subjected to surgical treatment for a huge intraligamental leiomyoma of the uterus, which weighed 3,370 g. A 48-year-old patient, without menstrual disorders and with a medical history of atypical symptoms from the digestive tract, was referred for a gynecological examination. Upon a physical examination, the abdomen was found to be bloated and distended, with no signs of peritoneal irritation. An intra-abdominal mass was suspected, the upper margin of which was palpable at about the level of the xiphoid process. The findings of computed tomography and magnetic resonance imaging confirmed the presence of a huge intra-abdominal mass, which probably originated from the internal genital organs. Following consultation with the patient, surgical treatment with laparotomy was decided. Intraoperatively, a large pedunculated subserosal leiomyoma was found, arising from the right lateral wall of the uterus with retroperitoneal extension within the leaves of broad ligament. Following the resection of the intraligamental leiomyoma, which had significant surgical challenges, a total hysterectomy with bilateral adnexectomy was performed. The post-operative course was smooth. In addition, in the present study, a brief review of intraligamental leiomyomas of the uterus is presented, emphasizing the significant diagnostic and surgical challenges and potential intraoperative complications that may arise in the management of patients with this condition.
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Affiliation(s)
- Anna Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Efthymia Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Vasiliki Grapsidi
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Emmanouil Xydias
- Department of Obstetrics and Gynecology, EmbryoClinic IVF, 55133 Thessaloniki, Greece
| | - Apostolos Ziogas
- Department of Medicine, University of Thessaly, School of Health Sciences, 41334 Larissa, Greece
| | | | | | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece
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Thanasa E, Thanasa A, Grapsidi V, Xydias EM, Kontogeorgis G, Antoniou IR, Kamaretsos E, Ziogas AC, Paraoulakis I, Thanasas I. Primary Large Broad Ligament Fibroid: A Challenge in Surgical Practice. Cureus 2023; 15:e51415. [PMID: 38299131 PMCID: PMC10828823 DOI: 10.7759/cureus.51415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 02/02/2024] Open
Abstract
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.
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Affiliation(s)
- Efthymia Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Anna Thanasa
- Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Vasiliki Grapsidi
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Emmanouil M Xydias
- Department of Obstetrics and Gynecology, EmbryoClinic IVF Unit, Thessaloniki, GRC
| | | | | | - Evangelos Kamaretsos
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Apostolos C Ziogas
- Department of Obstetrics and Gynecology, University of Thessaly, Larissa, GRC
| | - Ioannis Paraoulakis
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
| | - Ioannis Thanasas
- Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
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Review of uterine fibroids: imaging of typical and atypical features, variants, and mimics with emphasis on workup and FIGO classification. Abdom Radiol (NY) 2022; 47:2468-2485. [PMID: 35554629 DOI: 10.1007/s00261-022-03545-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 12/28/2022]
Abstract
Uterine fibroids are the most common gynecologic neoplasm. Although non-degenerated fibroids are easily identifiable on imaging, degenerated fibroids, fibroid variants, and fibroids with unusual growth patterns can constitute a diagnostic dilemma. Identification of these abnormal morphologic features can alter the diagnosis of presumed uterine fibroids and hence change management plans. This article reviews the typical and atypical radiologic imaging features of uterine fibroids, with an emphasis on the pitfalls, mimics, and radiologically identifiable features that can alter clinical management plans.
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