MYOMA OF THE ROUND LIGAMENT MIMICKING THE CLINICAL APPEARANCE OF THE INGUINAL HERNIA – A CASE REPORT
Abstract
Background. Myomas are the most frequent gynecological tumors. They first occur during puberty; however, they are most frequent among aged between 35 and 50. In this age group their incidence is 15–20%. They are rare after menopause. The majority of myomas arise in the uterus, but they may arise from other extrauterine sites such as the fallopian tubes, ovaries, round ligament, ligamentum latum, sacrouterine ligament, vagina and even the urethra. Most authors agree that there are numerous causes for the occurrence of myomas; however, they have not yet been clearly proven. They however agree that the myomas appear most frequently in the reproductive age, when the ovarian hormone levels are high and they diminish after menopause. They equally agree that the risk factors for the clinically significant myomas are nulliparity, obesity, a positive family history of myomas and African racial origin.
Patients and methods. A 43-year-old patient was referred to our institution for operative treatment by her personal gynaecologist who clinically and sonografically verified a solid tumor situated to the right side of the uterus. The size of the tumor was that of a newborn’s head. The patient, however, had been observing a reponible inguinal hernia the size of a female fist for a period of four years. A solid tumor (22×6×7 cm) arising from the right round ligament, was remowed during surgery. Half of its size was situated in the inguinal canal thus mimicking the clinical appearance of the inguinal hernia. After the tumor was removed the inner door of the inguinal canal closed by itself, no surgical repair was necessary. On histological examination the tumor was classified as a leiomyoma.
Conclusions. Although the leiomyoma of the round ligament is the most frequent tumor of that region it is a rare gynecological tumor. The described case is especially interesting due to the unusual position of the tumor. It was situated partly intraabdominally and partly inside the inguinal canal, thus mimicking the clinical appearance of the inguinal hernia.
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References
Berek JS ed. Novak’s Gynecology. Baltimore: Williams & Williams, 1995: 359–61.
Roberts CL, Marschall HK. Fibromyoma of the fallopian tube. Am J Obstet Gynecol 1961; 82: 364–4.
Fallahzadeh H, Dockerty MB, Lee RA. Leiomyoma of the ovary. Am J Obstet Gynecol 1972; 112: 394–4.
Breen JL, Neubecker RD. Tumors of the round ligament. A review of the literature and report of 25 cases. Obstet Gynecol 1962; 19: 771–80.
Tiwari OP, Gupta A, Gupta M. Leiomyoma of the vagina. The Indian Journal of Radiology and Imaging. 1999; 9(3). http:www.ijri.org/archives/19990903/index.html
Campbell S ed. Gynecology by ten teachers. 17th ed. London: Arnold, 2000: 116–7.
Williams PL, Worwick R, Dyson M, Bannister LH eds. Grey’s Anatomy. 37th ed. New York: Churchill Livingston, 1989.
Candiani GB, Vercellini P, Fedele L, Vendola N, Carinelli S, Scaglione V. Inguinal endometriosis: pathogenic and clinical implications. Obstet Gynecol 1991; 78: 191–4.
Harper GB Jr, Awbrey BJ, Thomas CG Jr, Askin FB. Mesothelial cysts of the round ligament simulating inguinal hernia. Report of four cases and a review of the literature. Am J Surg 1986; 151: 515–7.
Chhabra, Bala N. Huge leiomyoma of round ligament. The Antiseptic 2001; 98(4): 141–1.
Losch A, Haider-Angeler MG, Kainz C, Breitenecker G, Lahodny J. Leiomyoma of the round ligament in a postmenopausal woman. Maturitas 1999; 31(2): 133–5.
Warshauer DM, Mandel SR. Leiomyoma of the extraperitoneal round ligament: CT demonstration. Clinical Imaging 1999; 23: 375–6.
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