2019 Volume 35 Issue 1 Pages 169-174
Introduction: Leiomyomas of the round ligament of the uterus are rare. Two-thirds of these lesions originate from the extraperitoneal end of the round ligament and may be misdiagnosed as inguinal tumors that are operated by general surgeons. We report a case of a leiomyoma originating from the round ligament of the uterus, which was preoperatively diagnosed as a left ovarian tumor.
A 51-year-old woman presented to our hospital with the chief complaints of hypermenorrhea.
Plain pelvic magnetic resonance imaging showed multiple leiomyomas including a submucosal uterine leiomyoma, which was presumed to be the cause of hypermenorrhea. Additionally, a mass measuring 6 cm in size was identified on the left side of the pelvis. The mass was suspected to be a left ovarian tumor; thus, we planned laparoscopic surgery for the ovarian tumor and hysteroscopic myomectomy. The mass originated from the left-sided round ligament of the uterus, and the intact left ovary was observed posterior to the tumor. The tumor border was indistinguishable from the proper ligament of the left ovary; thus, we performed ablation of the left ovary. We cut the left-sided round ligament of the uterus and the suspensory ligament of the left ovary to avoid injury to the ureter. Thereafter, we cut the round ligament of the uterus and the proper ligament of the left ovary, and the tumor was removed. Histopathological examination revealed that the tumor was a leiomyoma.
Conclusion: Intrapelvic leiomyomas of the round ligament of the uterus are often asymptomatic; however, in a few patients, emergency surgery may be warranted for suspected torsion of an ovarian tumor. A normal ovary with a leiomyoma of the round ligament of the uterus can be identified by the course of the vessels feeding the leiomyoma. However, in this case preoperative diagnosis was difficult. It is necessary to carefully observe the course of the feeding vessels intraoperatively and cut the supporting tissue, ensuring that the ureter is not injured.
