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CLINICAL IMAGE
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 268-269

Rare pelvic fibroid – Round ligament fibroid


Department of Minimally Invasive Gynecology, Akanksha Hospital, Mumbai, Maharashtra, India

Date of Submission11-Jun-2020
Date of Decision04-Aug-2021
Date of Acceptance24-Aug-2021
Date of Web Publication5-Nov-2021

Correspondence Address:
Dr. Minal Dhanvij
504, Triveni Nagar, Malad East, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GMIT.GMIT_62_20

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How to cite this article:
Pisat S, Dhanvij M. Rare pelvic fibroid – Round ligament fibroid. Gynecol Minim Invasive Ther 2021;10:268-9

How to cite this URL:
Pisat S, Dhanvij M. Rare pelvic fibroid – Round ligament fibroid. Gynecol Minim Invasive Ther [serial online] 2021 [cited 2021 Dec 3];10:268-9. Available from: https://www.e-gmit.com/text.asp?2021/10/4/268/329874



A 24-year-old, thin built, virgin, female presented with swelling and pain on the left side of the abdomen and no menstrual complaints. Abdominal examination showed approximately 10 cm × 8 cm mobile solid mass palpable in left iliac fossa. Ultrasonography showed 10 cm × 8 cm × 7 cm hyperechogenic mass on the left lateral wall of the uterus. Laparoscopic findings revealed approximately 10 cm × 8 cm left round ligament fibroid having extensive blood supply, but uterus and adnexa were normal [Figure 1]a.
Figure 1: (a) Round ligament fibroid with extensive blood supply. (b) After injecting injection vasopressin. (c) Round ligament flaps after enucleation of fibroid. (d) Round ligament flap sutured

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Injection vasopressin (dilution 20 unit in 200 m NS) was injected with the help of visual vasopressor injection needle[1] which resulted in blanching [Figure 1]b. Fibroid was excised and two flaps of round ligament seen after enucleation of fibroid [Figure 1]c. The fibroid was removed from the abdominal cavity by morcellation. The round ligament flaps were sutured with vicryl [Figure 1]d. The postoperative recovery was uneventful, and the patient was discharged on the next day.

The round ligament is the extension of uterine musculature and mainly consists of smooth muscle fibers, connective tissue, vessels, and nerves. It derives its blood supply from small branch of uterine or ovarian artery known as Sampson artery.[2] Fibroid of female genital tract is because of somatic mutation of smooth muscle and complex interaction between sex steroids and growth factors mainly estrogen. Uterine fibroid is remarkably common benign tumor with the incidence of 77% in hysterectomy specimen, but round ligament fibroids are rare entity. Round ligament fibroid can present with adnexal neoplastic masses, inguinal hernia,[3] inguinal mass,[4] or vaginal mass with a low rate of painful symptoms. Preoperative diagnosis with ultrasonography and magnetic resonance imaging is challenging because of anatomic location near to the uterus and ovary.[5] Laparoscopic management is the first choice which is safe and feasible in this new era of minimal invasive surgery.[6]

Informed consent was obtained to publish this case. This original article was exempt from Institutional Review Board at Akanksha Hospital, Mumbai, Maharashtra, India, because there is no more than “minimal risk” and fits one of the exempt review category.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Acknowledgment

We thank our patient for giving us permission to publish our work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pisat S, van Herendael B. Pisat's visual vasopressor injection needle: An innovative tool for increasing patient safety in laparoscopic myomectomy. Surg Technol Int 2017;30:197-204.  Back to cited text no. 1
    
2.
Corton MM, DeLancey J. Surgical anatomy of female pelvis. In: Handa VL, Linda VL, editors. TeLinde's Operative Gynecology. 12th ed. India: Lippincott Williams and Wilkins; 2020. p. 50.  Back to cited text no. 2
    
3.
Colak E, Ozlem N, Kesmer S, Yildirim K. A rare inguinal mass: Round ligament leiomyoma. Int J Surg Case Rep 2014;4:577-8.  Back to cited text no. 3
    
4.
Lax DB, Thani SR. Case report of leiomyoma embedded within inguinal canal. JMIG 2016;23:756.  Back to cited text no. 4
    
5.
Bhargava P, Haque K, Vea R, Turbat-Herrera E, Chu Q, Sangster G, et al. Parasitic Leiomyoma presenting as a inguinal hernia in a postmenopausal women. Radiol Case Rep 2018;13:767-71.  Back to cited text no. 5
    
6.
Grossman SL, Cheung VY. Round ligament fibroid. J Obstet Gynaecol Can 2007;29:109.  Back to cited text no. 6
    


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