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Broad ligament adrenal rests are well known. A case of adrenal rest external to the surface of the broad ligament and adjacent to the fallopian tube is reviewed, with specific emphasis on its histogenesis. The rest is associated with a foreign body, and it is suggested that it has arisen as a secondary development of celomic epithelial metaplasia.
Pregnancy in the broad ligament is a rare form of ectopic pregnancy, and one type of abdominal pregnancy. The diagnosis is seldom established before surgery. A 38-year-old, 11-week pregnant woman, gravida 3, para 2, presented with vaginal bleeding. She had undergone two cesarean sections 10 and 6 years earlier. Pregnancy in the right broad ligament was diagnosed from clinical and transvaginal ultrasonographic findings. Emergency laparotomy and excision of a pregnancy in the right broad ligament and right salpingectomy were performed. She was well at discharge and at the 6-week follow up. We suggest the use of clinical and ultrasonographic findings for the suspicion of pregnancy in the broad ligament.
Malignant fibrous histiocytoma of the broad ligament origin is extremely rare. We report a case of a 64-year-old female with a broad ligament tumor mass, who underwent complete excision of the mass, total hysterectomy, and bilateral salpingo-oophorectomy. Pathology showed a malignant fibrous histiocytoma of the broad ligament. The postoperative course was uneventful and no radiation or chemotherapy was given. She has been carefully monitored for 16 months and is without recurrence.
The broad ligament is a double fold of peritoneum forming a mesentery for the human female genital tract. We investigated the anatomy of the broad ligament in different species and its hormonal regulation to determine if it had a role in gonadal positioning. The medical and veterinary literature was reviewed for descriptions of broad ligament anatomy and development. In addition, four adult female rats were dissected to compare the macroscopic anatomy of the broad ligament with any homologous structures in the male (n = 2). Detailed review was made of human males with persistent Müllerian duct syndrome (PMDS) and of bovine freemartin calves to determine the effect of abnormal hormonal environments on broad ligament development. Human and veterinary texts show variable broad ligament development between species, most being consistent with the size and shape of the uterus and uterine tubes. The broad ligament in adult female rats is a simple peritoneal fold and is homologous with the mesentery of the testis and vas deferens in males. Patients with PMDS and bovine freemartins have a broad ligament with intermediate anatomy. In PMDS the broad ligament is elongated and narrow, and not attached to the pelvic wall. The broad ligament is the mesentery of the genital ducts, and its anatomy varies with the degree of Müllerian duct fusion. The absence of a human male homologue is unusual, as the genital mesentery persists in male rodents. Apparent lack of a male homologue in the human may relate to obliteration of the processus vaginalis. The variable development of the broad ligament in pathological conditions is consistent with a role for steroid hormones in its development.
A defect in the broad ligament may be congenital or acquired. Due to such a defect, an internal hernia may develop. This usually involves the small bowel. We report a case of internal herniation of the small bowel due to a defect in the broad ligament diagnosed perioperatively. Computerized tomography is helpful in preoperative diagnosis of the condition and should be considered if the condition is suspected clinically. The defect should be closed surgically.
INTRODUCTION: Leiomyosarcoma of the broad ligament is an extremely rare malignant tumor, with only 13 cases reported. OBSERVATION: A 52 year-old woman consulted for pelvic pain and metrorrhagia. Clinical examination revealed a multinodular mass on the right side of the uterus. Pelvic ultrasound revealed a heterogeneous mass. Laparotomy found a malignant tumor arising from the right broad ligament. It was independent from the proximity organs. Treatment consisted in resection and total hysterectomy with bilateral salpingo-oophorectomy. The histologic examination led to the diagnosis of leiomyosarcoma. The patient died three months later. COMMENT: This is an exceptional case. Most authors underline the poor prognosis when tumoral relapse occurs early, as was the case in our patient.
The broad ligament containing uterine, paraovarian, and oviduct lymphatics was examined in the pig in various phases of the estrous cycle using light, scanning and transmission electron microscopy. The architecture of these regions differed and was independent of the lymphangions of the precollector and collector lymphatic vessels. Lymphangions were separated from mesothelium by connective tissue and/or muscle layers; however, in the vicinity of the thin walled paraovarian sac, large lymphangions were often compressed between two epithelial layers. Numerous lymphatic lacunae were in direct contact with the peritoneal and paraovarian sac cavities. The mesothelial lining of the broad ligament and the external and internal epithelium of the pig paraovarian sac displayed two distinct cell types. Only smaller cuboidal cells with prominent microvilli extended above the lymphatic endothelium. The surfaces of these cells were discontinuous and showed: 1) lymphatic stomata, 2) small pores or fenestrae, 3) a superficial network of epithelial-free communications with underlying connective tissue to the paraovarian sac in the postovulatory period independent of the lymphatic vasculature, and 4) endothelial (instead of epithelial) cells with crevice-like discontinuities in large portions of the internal sac surface during the follicular phase of estrus. Numerous lymphatic stomata had orifices composed of flattened cuboidal cells while lymphatic endothelial cells were characterized by macula or zonula adherent connections formed within rims of various sizes (up to 50 microns in diameter). During estrus, there were circular (0.5-2.0 microns) and irregular (to 10 microns) interendothelial openings in stomatal orifices with migrating cells. These morphologic findings suggest that absorption and passage of fluid, particles and cells between cavities and the lymphatic lumen in areas of the paraovarian lymphatic plexus in the pig is feasible.
BACKGROUND: Broad ligament pregnancy is an uncommon form of ectopic pregnancy. CASE: A 34-year-old, 11-week-pregnant woman, gravida 2, para 0, presented with left lower abdominal pain. She had undergone a right salpingectomy due to tubal pregnancy six years previously. She had a left broad ligament twin pregnancy, and excision of the pregnancy and left tube were performed. She was well at discharge and the six-week follow-up. CONCLUSION: This is the first case report of a broad ligament twin pregnancy after spontaneous conception.
Solitary tumors of the broad ligament are rare. The most frequent solid tumor of the broad ligament is leiomyoma. Leiomyosarcoma of the broad ligament (LBL) is an extremely rare malignant tumor. Nine cases of leiomyosarcoma of the broad ligament had been reported previously. A 59-year-old woman with LBL is reported. Treatment consisted of resection and total abdominal hysterectomy with bilateral salpingo-oophorectomy. No evidence of metastasis is noted after 12 months follow-up. We conclude that the management of LBL is excision of the leiomyosarcoma as completely as possible and postoperative adjuvant chemotherapy.
Malignant epithelial tumor of the broad ligament is rare and to our knowledge only 17 cases have been reported. We report a 54-year-old Japanese woman in whom transvaginal sonography (TVS) and magnetic resonance imaging (MRI) showed a left adnexal tumor. Serum CA125 was elevated to 10,000 U/ml. Preoperatively, we diagnosed this tumor was a left ovarian malignant tumor though, it was confirmed a the 47x57 mm tumor in the left broad ligament at laparotomy. Histologically most of the tumor showed serous papillary adenocarcinoma with changes similar to poorly differentiated carcinoma and as seen in transitional cell carcinoma on hematoxylin-eosin staining. After three courses of platinum based adjuvant chemotherapy, the patient is alive with no recurrence at 18 months postoperatively.
Internal herniation of small bowel through broad ligament causing obstruction is rare. A case of jejunal herniation through broad ligament defect with resultant obstruction and perforation is presented.
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Serous papillary cystadenoma of borderline malignancy arising in the broad ligament is extremely rare. We report the case of a 28-year-old female with a cystic mass in the broad ligament, who underwent complete excision of the mass, right salpingo-oophorectomy, omentectomy and multiple peritoneal biopsies. Pathology showed a serous papillary cystadenoma of borderline malignancy of the broad ligament, without peritoneal and omental involvement. A review of the literature about this rare pathologic condition is reported.
Internal herniation through the broad ligament is extremely rare. We report a case in which radiologic examinations including computed tomography (CT) were performed. A strangulated loop in the Douglas fossa was well-demonstrated by CT. CT can provide some clues to the diagnosis of this condition.
Leiomyosarcoma of the broad ligament is a rare tumor, since only 12 cases have been reported so far in the literature. A 53-year-old patient was diagnosed with leiomyosarcoma of the broad ligament at the Department of Gynecology Oncology of the National Cancer Research Institute in Genoa. The tumor had low mitotic activity and less than ten mitotic figures were found for ten high-power fields. The treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy with bilateral ureteral neoanastomosis and omentectomy. The patient has not received either radiotherapy or chemotherapy, considering the low grade of malignancy, but she is only followed up on an outpatient basis. No evidence of metastasis has been noted after a follow-up of 13 months. It is concluded that low-grade leiomyosarcoma of the broad ligament should be treated only with surgery.
Adenomyosis confined to the broad ligament is extremely rare. Herein we present a case of adenomyosis in the broad ligament with unusual gross features. This 41-year-old woman had been on tamoxifen therapy for 3 years due to breast cancer. Ten months after discontinuing tamoxifen, she underwent exploratory laparotomy for a right adnexal mass suspected as ovarian malignancy. At laparotomy, the mass was located in the right broad ligament with a fibrous stalk connecting to the uterus. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histopathologic examination revealed adenomyosis with cyst formation and an unusual thick capsule. The possible effects of tamoxifen upon the uterus are discussed in this article, in view of reports of tamoxifen associated with endometrial carcinoma and endometriosis.
Pulmonary embolism is a common postoperative complication in gynecological oncology patients and is often fatal. A substantial proportion of venous thrombi responsible for pulmonary emboli originate in the pelvic veins. The significance of thrombi in the veins of the broad ligament identified in surgical specimens is unknown. In a case-control study, women with postoperative pulmonary embolism (cases) were identified from the Gynecological Oncology service at the Washington Hospital Center and compared with consecutive surgical pathology accessions (controls). Only the broad ligament veins were evaluated for the presence of organizing thrombi. Eight patients, all of whom had a gynecological malignancy, were diagnosed postoperatively with pulmonary embolism. Six were diagnosed clinically by spiral CT from 4 to 115 days after surgery, and two were diagnosed by open lung biopsy of a new pulmonary lesion approximately 1 year postoperatively. None of the cases was shown to have thrombi in the broad ligament veins. Thrombi in the broad ligament veins were present in three of 30 control patients with malignancies. Among 56 controls without malignancies, 3 had broad ligament thrombi. These findings suggest that the presence of organizing thrombi in the broad ligament veins does not predict postoperative pulmonary embolism.
A case of intestinal obstruction resulting from passage of the entire small bowel and cecum and its mesentery through a fenestration in the broad ligament of the uterus is presented. A review of the literature reveals that broad ligament defects may occur in multiple locations, which may be responsible for intestinal obstruction. A simple classification of broad ligament defects is proposed. Type 1 defects occur caudal to the round ligament of the uterus. Type 2 defects occur above the round ligament. Type 3 defects occur between the round ligament and the remainder of the broad ligament, through the meso-ligamentum teres.