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The Broad Ligament Fibroid

  • Jonathan Y. Song
  • Carlos Rotman
  • Edgardo L. Yordan
Chapter

Abstract

Although broad ligament myomas are the most common of the extrauterine myomas, they are rare, with an incidence of approximately 1%. Their location can cause unusual presentations and potentially compromise the accuracy of a preoperative diagnosis. Because the location is peculiar due to the complex anatomy in this region (i.e., ureters and internal iliac and obturator vessels and nerves), the surgeon must pay close attention during dissection.

Keywords

Broad ligament fibroid Myomectomy Laparoscopy Infertility Tissue extraction SLAM Morcellation 

Supplementary material

Video S1

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References

  1. 1.
    Sparic R, Mirkovic L, Malvasi A, Tinelli A. Epidemiology of uterine myomas: a review. Int J Fertil Steril. 2016;9(4):424–35.PubMedGoogle Scholar
  2. 2.
    Rein MS, Barbieri RL, Friedman AJ. Progesterone: a critical role in the pathogenesis of uterine myomas. Am J Obstet Gynecol. 1995;172(1 Pt 1):14–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Andersen J. Growth factors and cytokines in uterine leiomyomas. Semin Reprod Endocrinol. 1996;14(3):269–82.CrossRefPubMedGoogle Scholar
  4. 4.
    Fields KR, Neinstein LS. Uterine myomas in adolescents: case reports and a review of the literature. J Pediatr Adolesc Gynecol. 1996;9(4):195–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94(4):435–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Ryan GL, Syrop CH, Van Voorhis BJ. Role, epidemiology, and natural history of benign uterine mass lesions. Clin Obstet Gynecol. 2005;48(2):312–24.CrossRefPubMedGoogle Scholar
  7. 7.
    Lippman SA, Warner M, Samuels S, Olive D, Vercellini P, Eskenazi B. Uterine fibroids and gynecologic pain symptoms in a population-based study. Fertil Steril. 2003;80(6):1488–94.CrossRefPubMedGoogle Scholar
  8. 8.
    Sparic R, Hudelist G, Berisavac M, Gudovic A, Buzadzic S. Hysterectomy throughout history. Acta Chir Iugosl. 2011;58(4):9–14.CrossRefPubMedGoogle Scholar
  9. 9.
    Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990–1997. Obstet Gynecol. 2002;99(2):229–34.PubMedGoogle Scholar
  10. 10.
    Merrill RM. Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit. 2008;14(1):CR24–31.PubMedGoogle Scholar
  11. 11.
    Lurie S, Piper I, Woliovitch I, Glezerman M. Age-related prevalence of sonographically confirmed uterine myomas. J Obstet Gynaecol. 2005;25:42–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Laughlin SK, Baird DD, Savitz DA, Herring AH, Hartmann KE. Prevalence of uterine leiomyomas in the first trimester of pregnancy: an ultrasound-screening study. Obstet Gynecol. 2009;113(3):630–5.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Chen CR, Buck GM, Courey NG, Perez KM, Wactawski-Wende J. Risk factors for uterine fibroids among women undergoing tubal sterilization. Am J Epidemiol. 2001;153(1):20–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Borgfeldt C, Andolf E. Transvaginal ultrasonographic findings in the uterus and the endometrium: low prevalence of leiomyoma in a random sample of women age 25–40 years. Acta Obstet Gynecol Scand. 2000;79(3):202–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Marino JL, Eskenazi B, Warner M, Samuels S, Vercellini P, Gavoni N, Olive D. Uterine leiomyoma and menstrual cycle characteristics in a population-based cohort study. Hum Reprod. 2004;19(10):2350–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Wise LA, Palmer JR, Stewart EA, Rosenberg L. Age-specific incidence rates for self-reported uterine leiomyomata in the black Women’s health study. Obstet Gynecol. 2005;105:563–8.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kjerulff KH, Langenberg P, Seidman JD, Stolley PD, Guzinski GM. Uterine leiomyomas. Racial differences in severity, symptoms and age of diagnosis. J Reprod Med. 1996;41:483–90.PubMedGoogle Scholar
  18. 18.
    Ross RK, Pike MC, Vessey MP, Bull D, Yeates D, Casagrande JT. Risk factors for uterine fibroids: reduced risk associated with oral contraceptives [Published correction appears in Br Med J (Clin Res Ed) 1986;293:1027]. Br Med J (Clin Res Ed). 1986;293:359–62.CrossRefGoogle Scholar
  19. 19.
    Ligon AH, Morton CC. Leiomyomata: heritability and cytogenetic studies. Hum Reprod Update. 2001;7:8–14.CrossRefPubMedGoogle Scholar
  20. 20.
    Chiaffarino F, Parazzini F, La Vecchia C, Marsico S, Surace M, Ricci E. Use of oral contraceptives and uterine fibroids: results from a case-control study. Br J Obstet Gynaecol. 1999;106:857–60.CrossRefPubMedGoogle Scholar
  21. 21.
    Lumbiganon P, Rugpao S, Phandhu-fung S, Laopaiboon M, Vudhika-mraksa N, Werawatakul Y. Protective effect of depot-medroxyprogesterone acetate on surgically treated uterine leiomyomas: a multicentre case-control study. Br J Obstet Gynaecol. 1996;103:909–14.CrossRefPubMedGoogle Scholar
  22. 22.
    Kurman RJ, editor. Blaustein’s pathology of the female genital tract. 5th ed. New York: Springer; 2002.Google Scholar
  23. 23.
    Pallavee P, Ghose S, Begum J, et al. Fibroid after hysterectomy: diagnostic dilemma. J Clin Diagn Res. 2014;8:1–3.CrossRefGoogle Scholar
  24. 24.
    Bhatla N. Tumours of the corpus uteri. Jeffcoats principles of gynaecology. 6th ed. London: Arnold Printers; 2001. p. 470.Google Scholar
  25. 25.
    Harrison BT, Berg RE, Mittal K. Massive ovarian edema associated with a broad ligament leiomyoma: a case report and review. Int J Gynecol Pathol. 2014;33:418–22.CrossRefPubMedGoogle Scholar
  26. 26.
    Song JY. Laparoscopic resection of a rare, large broad ligament myoma. J Minim Invasive Gynecol. 2015;22(4):530–1.CrossRefPubMedGoogle Scholar
  27. 27.
    Amant F, Coosemans A, Debiec-Rychter M, et al. Clinical management of uterine sarcomas. Lancet Oncol. 2009;10:1188.CrossRefPubMedGoogle Scholar
  28. 28.
    Schwartz LB, Zawin M, Carcangiu ML, et al. Does pelvic magnetic resonance imaging differentiate among the histologic subtypes of uterine leiomyomata? Fertil Steril. 1998;70:580.CrossRefPubMedGoogle Scholar
  29. 29.
    Goto A, Takeuchi S, Sugimura K, et al. Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus. Int J Gynecol Cancer. 2002;12:354.CrossRefPubMedGoogle Scholar
  30. 30.
    Tanaka YO, Nishida M, Tsunoda H, et al. Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings. J Magn Reson Imaging. 2004;20:998.CrossRefPubMedGoogle Scholar
  31. 31.
    Baird DD, Dunson DB, Hill MC, et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188:100.CrossRefPubMedGoogle Scholar
  32. 32.
    Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989–1999. Gynecol Oncol. 2004;93:204.CrossRefPubMedGoogle Scholar
  33. 33.
    Fang Z, Matsumoto S, Ae K, et al. Postradiation soft tissue sarcoma: a multi-institutional analysis of 14 cases in Japan. J Orthop Sci. 2004;9(3):242.CrossRefPubMedGoogle Scholar
  34. 34.
    Giuntoli RL 2nd, Metzinger DS, DiMarco CS, et al. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol. 2003;89(3):460.CrossRefPubMedGoogle Scholar
  35. 35.
    Wickerham DL, Fisher B, Wolmark N, et al. Association of Tamoxifen and uterine sarcoma. J Clin Oncol. 2002;20:2758.CrossRefPubMedGoogle Scholar
  36. 36.
    Wysowski DK, Honig SF, Beitz J. Uterine sarcoma associated with tamoxifen use. N Engl J Med. 2002;346:1832.CrossRefPubMedGoogle Scholar
  37. 37.
    Moinfar F, Azodi M, Tavassoli FA. Uterine sarcomas. Pathology. 2007;39:55.CrossRefPubMedGoogle Scholar
  38. 38.
    Launonen V, Vierimaa O, Kiuru M, et al. Inherited susceptibility to uterine leiomyomas and renal cell cancer. Proc Natl Acad Sci U S A. 2001;98(6):3387.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Toro JR, Nickerson ML, Wei MH, et al. Mutations in the fumarate hydratase gene cause hereditary leiomyomatosis and renal cell cancer in families in North America. Am J Hum Genet. 2003;73(1):95.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    CL Y, Tucker MA, Abramson DH, et al. Cause-specific mortality in long-term survivors of retinoblastoma. J Natl Cancer Inst. 2009;101(8):581.CrossRefGoogle Scholar
  41. 41.
    Sener AB, Seçkin NC, Ozmen S, et al. The effects of hormone replacement therapy on uterine fibroids in postmenopausal women. Fertil Steril. 1996;65(2):354.CrossRefPubMedGoogle Scholar
  42. 42.
    Polatti F, Viazzo F, Colleoni R, et al. Uterine myoma in postmenopause: a comparison between two therapeutic schedules of HRT. Maturitas. 2000;37(1):27.CrossRefPubMedGoogle Scholar
  43. 43.
    Ang WC, Farrell E, Vollenhoven B. Effect of hormone replacement therapies and selective estrogen receptor modulators in postmenopausal women with uterine leiomyomas: a literature review. Climacteric. 2001;4(4):284.CrossRefPubMedGoogle Scholar
  44. 44.
    Yang CH, Lee JN, Hsu SC, et al. Effect of hormone replacement therapy on uterine fibroids in postmenopausal women—a 3-year study. Maturitas. 2002;43(1):35.CrossRefPubMedGoogle Scholar
  45. 45.
    Song JY. Laparoscopic resection of the large broad ligament fibroid. Washington, D.C.: Surgical video session presented at the meeting of the American Association of Gynecologic Laparoscopists; 2013.Google Scholar
  46. 46.
    Hasson HM, Rotman C, Rana N, et al. Open laparoscopy: 29-year experience. Obstet Gynecol. 2000;96(5 P 1):763–6.PubMedGoogle Scholar
  47. 47.
    Hasson HM, Rotman C. Laparoscopic myomectomy. In: Sanfilippo JS, Levine RL, editors. Operative gynecologic endoscopy. 2nd ed. New York: Springer; 1996. p. 89–103.CrossRefGoogle Scholar
  48. 48.
    Song JY, Borncamp E, Mehaffey P, Rotman C. Large abdominal wall endometrioma following laparoscopic hysterectomy. JSLS. 2011;15(2):261–3.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Rotman C, Rana N, Song JY, et al. Laparoscopic tubal anastomosis. In: Rizk B, Garcia-Velasco J, Sallam H, Makrigiannakis A, editors. Infertility and assisted reproduction. Cambridge: Cambridge University Press; 2008. p. 91–8.CrossRefGoogle Scholar
  50. 50.
    Kashani BN, Centini G, Morelli S, et al. Role of medical management for uterine leiomyomas. Best Pract Res Clin Obstet Gynaecol. 2016;34:85–103.CrossRefPubMedGoogle Scholar
  51. 51.
    Conforti A, Mollo A, Alviqqi C, et al. Techniques to reduce blood loss during open myomectomy: a qualitative review of literature. Eur J Obstet Gynecol Reprod Biol. 2015;192:90–5.CrossRefPubMedGoogle Scholar
  52. 52.
    Zhang Y, Sun L, Guo Y, et al. The impact of preoperative gonadotropin-releasing hormone agonist treatment on women with uterine fibroids: a meta-analysis. Obstet Gynecol Surv. 2014;69(2):100–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Bassaw B, Mohammed N, Jaqqat A, et al. Experience with a gonadotropin-releasing hormone agonist prior to myomectomy-comparison of twice vs. thrice monthly doses and a control group. J Obstet Gynaecol. 2014;34(5):415–9.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • Jonathan Y. Song
    • 1
  • Carlos Rotman
    • 2
  • Edgardo L. Yordan
    • 2
  1. 1.Robotics and Minimally Invasive SurgeryNorthwestern Medicine Delnor Hospital, TLC Medical GroupSt. CharlesUSA
  2. 2.Department of GynecologyWeiss Memorial HospitalChicagoUSA

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