Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12696
Peer-review started: July 28, 2022
First decision: September 27, 2022
Revised: October 11, 2022
Accepted: November 2, 2022
Article in press: November 2, 2022
Published online: December 6, 2022
Processing time: 127 Days and 3.3 Hours
The treatment of large pelvic masses in postmenopausal women is a challenge in clinical practice. Although ultrasound or magnetic resonance imaging can be used to determine the size and location of the mass, it is still difficult to achieve a preoperative diagnosis. The majority of cellular leiomyomas are diagnosed by histopathology after surgery. We report the differential diagnosis and surgical management of a rare case of cellular leiomyoma in the broad ligament of the uterus.
A 52-year-old Chinese woman without sexual history was admitted to the First Affiliated Hospital of Guangzhou University of Chinese Medicine for the first time. The patient had a 1-year history of progressive abdominal enlargement as well as a 2-year history of menopause, and complained of frequent abdominal pain and low-grade fever. Computed tomography of the abdomen showed a solid cystic mass (29.4 cm × 18.8 cm × 37.7 cm) in the pelvis and abdomen. Moreover, routine blood test results indicated a baseline cancer antigen 125 (CA-125) level of 187.7 U/mL and C-reactive protein of 109.58 mg/L. Subsequently, retrograde hysterectomy and bilateral adnexectomy were performed in this patient. On histopathologic examination of the surgical specimen, a rare cellular leiomyoma in the broad ligament was diagnosed.
Clinicians need to constantly improve diagnosis and treatment for the challenges posed during clinical assessment, differential diagnosis, and surgical management.
Core Tip: Initially, a gynecological malignancy was suspected due to an elevated tumor blood index and large abdominal mass of unknown nature in this unmarried, childless middle-aged woman. The importance of differential diagnosis in this case was crucial and removal of the mass was also challenging. We performed an unconventional hysterectomy to ensure a smooth operation, which indicates the importance of surgical choice.