Tumors of the broad ligament: what and when to suspect such rare location

Abstract Although secondary involvement of the broad ligament by malignant tumors arising elsewhere in the abdomen and pelvis is common, primary tumors in this location are rare. Tumors of the broad ligament can be of mesenchymal and mixed nature, such as leiomyoma, the most common neoplasm; epithelial tumors of Müllerian type, imposing a challenge to differentiate them from other adnexal masses; unique tumors from mesonephric origin; and tumor-like lesions. Most neoplasms in this region, whether benign or malignant, usually present clinically with vague symptoms and are often discovered during a routine gynecological examination. Suspicion of such location and knowledge of the potential range of lesions of this region may allow for planning minimally invasive surgical interventions. To be considered tumor from the broad ligament, it should not be connected with either the uterus or the ovary. Thus, the imaging approach to establish the differential diagnosis includes excluding an ovarian, uterine, or tubal origin by recognizing these separately and by rebutting imaging clues pointing to these origins. This pictorial essay reviews some of the imaging findings that may suggest such location and presents some of the possible differential diagnoses by means of illustrative confirmed cases.

摘要 尽管腹部与盆腔其他部位起源的恶性肿瘤继发累及阔韧带的情况较为常见，但原发于该部位的肿瘤却十分罕见。阔韧带肿瘤可分为间叶源性及混合性两类，其中最常见的为平滑肌瘤（leiomyoma）；还包括米勒型（Müllerian）上皮性肿瘤，此类肿瘤与其他附件肿块的鉴别颇具难度；另有起源于中肾（mesonephric）的特殊肿瘤，以及瘤样病变。该区域的多数肿瘤，无论良性或恶性，临床症状多较隐匿，通常在常规妇科检查中偶然发现。若能警惕此类病变的好发部位，并了解该区域可能出现的各类病变，即可规划微创外科干预方案。若要确诊为阔韧带原发肿瘤，其不应与子宫或卵巢相连。因此，用于明确鉴别诊断的影像学检查需通过分别识别子宫、卵巢及输卵管，并排除指向这些器官来源的影像学征象，从而排除卵巢、子宫或输卵管来源的肿瘤。本图解综述回顾了可提示病变起源于阔韧带的影像学表现，并通过经证实的典型病例展示了相关鉴别诊断思路。