(* Professor and Head, Obstetrics and Gynecology, Seth G S Medical College & K E M Hospital, Mumbai, India.)
Figure 3. The superior part of the pseudo-capsule is divided (arrows) to expose the leiomyoma (L) within it.
Figure 4. The leiomyoma (L) is being enucleated from within its pseudocapsule.
Figure 5. The leiomyoma has been enucleated. The bed of the leiomyoma is seen (arrows).
Figure 6. End result. The suture line in the right broad ligament is seen.
The presentation of cervical leiomyoma usually depend on the location. It can present with symptoms like menstrual irregularities, constipation, frequency of urination, urinary retention, dyspareunia and postcoital bleeding.[3,4] A large size of a cervical leiomyoma can cause anatomical distortion of ureter, bladder and uterine vessels, thereby increasing the risk of injury to these structures. The progression in the number, size and growth of cervical leiomyomas is unpredictable. They usually do not become become cancerous. They are less likely to shrink on their own until after menopause.
In our case it was a posterior cervical leiomyoma which was arising from the supravaginal part of the cervix. Two unusual features of this leiomyoma were its growth into the right broad ligament and stretching of only the posterior leaf of right broad ligament over it. Leiomyomas arising from the posterior part of the supravaginal cervix usually do not grow into the broad ligament which lies lateral to it. Once a leiomyoma grows in the broad ligament, it stretches both leaves of the broad ligament over it. Both of these features were absent in our case. Due to this unusual location the ureter was expected to lie not only lateral to the leiomyoma but also on the top of it. Luckily it was on the lateral pelvic wall in its upper pelvic part and below the leiomyoma in its lower pelvic wall. This leiomyoma was reached by opening the anterior leaflet of right broad ligament by dividing the right round ligament, which was the safest approach for avoiding the right ureter. Adequate exposure of the leiomyoma was possible without injuring the right fallopian tube when the broad ligament was dissected off its upper surface of the leiomyoma, displacing the right fallopian tube posteriorly. Dissection within the pseudocapsule was the key principle used to avoid ureteric injury.
- Bhatla N. Tumors of the corpus uteri. In: Jeffcoates Principles of Gynaecology. 6th ed. London: Arnold Publisher; 2001. p. 470.
- Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives. Int J Women's Health. 2014; 6: 95-114.
- Buttram VC Jr., Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981;36:433
- Parker WH. Uterine myomas: An overview of development, clinical features, and management. Obstet Gynecol 2005;105:216-7.
- Rajput DA, Gedam JK. Broad ligament fibroid: A case series. IJSS Case Rep Rev 2015;1:8-11.
Panchbudhe SA, Parulekar SV. A Unusual Case Of Cervical Pseudo Broad Ligament Leiomyoma. JPGO 2018. Vol 5 No. 12. Available from: https://www.jpgo.org/2018/12/a-unusual-case-of-cervical-pseudo-broad.html