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case_images: Computed tomography scan illustrating a huge intrauterine leiomyoma of the uterus: A large, mixed echogenicity mass with well-defined margin (white arrows) is evident, occupying most of the peritoneal cavity
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case_images: The intra-abdominal mass had a multilobulated shape and was of mixed consistency, with marked post-contrast enhancement of solid elements (Fig. 1).
case_images: Magnetic resonance imaging of a huge intraligamental leiomyoma of the uterus: The space-occupying lesion is depicted by white arrows with lobulated margins and extensive nodular solid and cystic necrotic elements, nodular wall protrusions and multiple internal septations; it corresponds to a uterine leiomyoma with growth within the broad ligament.
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case_images: The lesion was depicted with lobulated indistinct borders and had extensive nodular solid and cystic necrotic elements, nodular wall protrusions and multiple internal septations, presenting inhomogeneous enhancement in the paramagnetic substance (Fig. 2).
case_images: Intraoperative image of a huge intraligamental leiomyoma of the uterus: The extension of the tumur into the retroperitoneal space within the leaves of the broad ligament is evident. At the same time, the presence of multiple subserosal and intramural uterine leiomyomas (black arrows) and the displacement of both ovaries are depicted.
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case_images: The presence of other smaller uterine fibroids was evident (Fig. 3).
case_images: Intraoperative image of a huge intraligamental leiomyoma of the uterus, originating (yellow arrows) from the right lateral wall of the uterus.
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case_images: Subsequently, with the use of the electrothermal bipolar vessel sealing device and using suture ligation where necessary, the fibroid (weighing 3,370 g) was dissected from the leaves of the broad ligament and resected following the ligation and dissection of the vascular pedicle in the lateral right wall of uterus (Fig. 4).
case_images: Histological image of intraligamental leiomyoma of the uterus: Leiomyoma with cystic and hydropic degeneration is shown (hematoxylin and eosin staining; magnification, x40).
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case_images: No necrosis or severe cellular atypia was observed (Fig. 5).
case_images: Immunohistochemical images of leiomyoma illustrating: (A) CD10 negativity (magnification, x100), (B) estrogen receptor (ER) focal weak positivity (magnification, x100), (C) Ki67, 7% (magnification, x400), (D) smooth muscle actin positivity (magnification, x40).
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case_images: The following results were obtained: Ki67, 7%; SMA (+), weakly positive for ER, and negative for CD10 (Fig. 6).