29. Angioleiomyoma with a plexiform pattern in the broad ligament – A case report

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Background: Angioleiomyoma (ALM) is an uncommon benign mesenchymal neoplasm that originates from smooth muscle cells and contains numerous thick-walled blood vessels. Aim: We are presenting a case report of a rare ALM with a plexiform pattern arising from the broad ligament. Methods: A 46-year-old female presented with lower abdominal pain. US scan revealed bilateral adnexal masses with increased vascularity. The left adnexal mass was 50 mm with internal vascularity. The left adnexal mass, measuring 50×40×20 mm in aggregate revealed a haemorrhagic solid and cystic cut surface with a smooth outer surface. Histology showed a benign spindle cell tumour composed of bland spindle cells arranged in a plexiform pattern. There were many intermingled thick walled blood vessels. Nuclear atypia, increased mitosis and necrotic areas were absent. The tumour cells were strongly positive for SMA, Desmin, ER, PR, focally positive for CD34. The tumour cells were negative for EMA, AE1/AE3, S100 and STAT-6. The diagnosis was ALM with a plexiform pattern likely arising from the broad ligament. The clinical and radiological findings showed normal bilateral ovaries, fallopian tubes and a fibroid uterus. Results and conclusion: ALM is a benign mesenchymal neoplasm commonly found in the skin of extremities and rarely occurs in uterus. The ALM arising from broad ligament is much rarer than the uterine counterpart. There has been only three reported cases of ALM arising from broad ligament after extensive literature review. The patients with uterine and broad ligament angioleiomyomas usually present with abdominal pain which is believed to be related to ischemia due to vascular contraction. It has to be differentiated from the other mesenchymal neoplasms with prominent vascular components and the differential diagnosis includes angiofibroma, angiomyolipoma, angiomyofibroblastoma and perivascular epitheloid tumours. A large broad-ligament lesion can mimic ovarian masses and preoperative imaging and histopathologic confirmation may help in avoiding radical surgery.