A rare presentation of degenerating broad ligament fibroid with pseudomeigs syndrome, pelvic organ prolapse and gross uterine displacement-A case report and review of literature

Abstract

41 year old , P1L1, presented with abdomen pain , abdominal distension, stress incontinence and increased urinary frequency ,for the past 6 months and was referred with diagnosis of malignant ovarian mass. Examination of abdomen revealed irregular mass of size corresponding to 28 weeks gravid uterus. Another globular mass was palpable in the right inguinal region .Examination also showed grade 2 cystocele along with grade 3 enterocele. Imaging revealed a huge heterodense mass arising from the pelvis extending upto the epigastric region , displacing bowel loops laterally and uterus towards right inguinal region. The patient had pleural effusion on left side. Serum CA 125 was 102.67 IU ml. The patient was planned for staging laparotomy along with cystocele and enterocele repair. Intraoperative finding was that uterus was normal in size , grossly deflected to right and cervix stretched out .Left ovary, Right tube and right ovary were normal. A mass of size 25 20 20 cm was present within leaves of left broad ligament distorting the course of the left ureter. The mass was removed after delineating the ureter. TAH with BSO done. Moschcowitz suture to prevent    enterocele recurrence , paravaginal defect repair for cystocele and retropubic colposuspension for stress urinary   incontinence were done .Histopathology of the mass showed leiomyoma with areas of cystic and myxoid degeneration . The case is reported for its rarity and the diagnostic difficulties it posed.