Symptomatic internal hernia of the broad ligament: a complication of electrocoagulation therapy of endometriosis

A 31-year-old nulligravid woman had had two previous laparoscopies for endometriosis. Disease of the right broad ligament was treated by electrocoagulation at the first surgery, but pain persisted despite postoperative danazol therapy. At her second laparoscopy, a large defect of the right broad ligament was noted, but not treated. At her third operation, laparoscopic excision of endometriosis was followed by herniorrhaphy of the right broad ligament through mini-laparotomy. The potential for bowel herniation exists whenever a closed loop is present in the abdominal cavity.

Malignant fibrous histiocytoma of the broad ligament: a case report and literature review

A case of malignant fibrous histiocytoma arising primarily in the broad ligament is described. This entity has not been previously reported. The patient's presentation and clinical course, including her partial response to Adriamycin and DTIC chemotherapy, are outlined. Clinical and pathologic features of tumors arising in the broad ligament are discussed.

Bupivacaine infiltration of the mesosalpinx in ambulatory surgical laparoscopic tubal sterilization

Bupivacaine infiltration of the mesosalpinx was compared to lidocaine, normal saline or no injection for pain relief in women having elective laparoscopic tubal sterilization by Yoon fallopian ring application. One hundred women were assigned randomly to four groups. In a double-blind study, the mesosalpinx was infiltrated in three groups: Group 1 - lidocaine one per cent; Group II - bupivacaine 0.5 per cent; Group III - normal saline. Group IV (control) received no injection. Pain intensity was reported at four study times by the patients on a self-assessment pain intensity scale. Responses were compared using the Kruskall-Wallis H-Test and Wilcoxen's Rank-Sum Test. Both tests indicated significant differences in pain intensity levels at various study times. The amount of supplemental fentanyl given was used as a secondary measure of effectiveness. One-way analysis of variance (ANOVA) and Duncan's Multiple-Range Test showed the bupivacaine group to receive significantly less fentanyl (p less than 0.05) in the postanaesthesia care unit.

Leiomyosarcoma of the broad ligament--report of a case

A 31-year-old woman with a leiomyosarcoma of the broad ligament discovered during pregnancy is described. Treatment consisted of resection followed by pelvic irradiation. The patient experienced distant visceral metastases with disease control in the pelvis 30 months after diagnosis.

Leiomyoma of the broad ligament in an obturator hernia presenting as a lump in the groin

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Intraligamentary pregnancy resulting in a live infant

Presented is the case of a woman with an ectopic pregnancy in the left broad ligament, which resulted in a live, healthy infant. Despite the characteristic history of an abdominal crisis early in pregnancy and complaints of abdominal pain throughout pregnancy, the correct diagnosis was not established until cesarean section.

Ependymoma of the broad ligament. A report of two cases

The clinical and pathological features of two cases of ependymoma that originated in the broad ligament are reported. Metastases developed in both patients. The tumors had the distinctive features of ependymoma on light-microscopical examination, and the diagnosis was confirmed by ultrastructural study in one case and immunoperoxidase staining for glial fibrillary acidic protein in both cases. The tumors presented diagnostic difficulties because of their close resemblance to serous papillary carcinomas of the ovary and the absence of published reports of ependymoma occurring in the female genital tract.

Papillary tumor of the broad ligament

A 43-year-old woman received a hysterectomy with bilateral adnexectomy for a cystic tumor of the right broad ligament. The tumor, measuring 10 cm in diameter, was apart from the ovaries, oviducts, or uterus. The cyst wall had well-developed smooth muscle layers. Cells lining the cyst were benign-looking, relatively low columnar type, and were compatible with those of mesonephric origin. From the inner surface of the cyst numerous cauliflower-like structures projected into the lumen. These were predominantly papillary architecture covered by epithelial cells with occasional solid or glandular growth. Although structural and cellular atypism may suggest its malignant nature, the validity for frank malignancy of the present tumor could not be gained because of the absence of capsular invasion and metastasis. So, the diagnosis of papillary tumor of borderline malignancy was made. It may be safely assumed that the papillary tumor arose in a preexisting parovarian cyst of mesonephric origin.

Papillary serous cystadenoma of borderline malignancy arising in a parovarian paramesonephric cyst. Light microscopic and ultrastructural observations

This is the first ultrastructural study of a neoplasm arising in a parovarian Müllerian (paramesonephric) cyst. By light and electron microscopy this tumour bore a close resemblance to the ovarian serous cystadenoma of borderline malignancy. This resemblance to serous neoplasms of the ovary and to other tumours of Müllerian duct derivation was the strongest claim to its origin. Other features which indicated Müllerian origin included the absence of a well-defined basement membrane, the presence of distinct muscle coats and the relatively large size of the epithelial cells and their nuclei. We suggest that the same prognostic criteria used for ovarian serous tumours might be applicable to the present lesion and conclude that Müllerian adnexal tumours like their Wolffian counterparts can also be identified by their morphological characteristics.

Paramesonephric papillary serous cystadenocarcinoma: a case report with scanning electron microscopy

A case report of a malignant tumor, presumably paramesonephric in origin, is presented. Although uncommon, malignancies of the cystic structures of the broad ligament have been reported. The embryologic derivations and histologic feature of these tumors--mesonephric, mesothelial and paramesonephric--have been describe extensively, but no primary lesion has been evaluated previously by scanning electron microscopy. A prior laparotomy and biopsy with a diagnosis of a malignant papillary growth, probably paramesonephric, stimulated the examination of fresh tissue by an ETEC Autoscan scanning electron microscope at subsequent definitive, ablative surgery. Although features of cellular dysplasia were noted, there were no specific, unique characteristics of this neoplasm. Since all reported cases have been premenopausal, a hormonal interaction is questioned.

[Internal hernia through an orifice of the broad ligament of the uterus]

A case of hernia-induced occlusion of the small intestine through an orifice of the broad ligament of the uterus is reported. After reviewing the literature, the pathogenetic aspects are considered, with reference to the congenital or acquired origin of the defect. Clinically, the most significant factors for diagnosis are the patient's multipara condition, previous obstetrico-gynaecological operations, signs of mechanical type intestinal occlusion and palpation of a parauterine mass. Surgical treatment involves straightforward mechanical ileus with repair of the occluding orifice.

Extraovarian Brenner tumor. Case report and review

We present the fourth case report of an extraovarian Brenner tumor, which was an incidental finding in a total hysterectomy 53-year-old woman. The morphology and pathogenesis of Brenner tumors are discussed.

Pheochromocytoma of the broad ligament. Localization by computerized tomography and ultrasonography

Computerized tomography (CT) and ultrasonography demonstrated a pheochromocytoma of the broad ligament of the uterus in a patient in whom arteriographic findings had been negative. We suggest that either or both of these techniques be used initially because, although they are not histologically specific, they are noninvasive and sensitive. An additional advantage of CT is its ability to evaluate sites of extra-adrenal pheochromocytomas above the diaphragm.