Introduction: Broad ligament leiomyomas are rare extrauterine smooth muscle tumors accounting for less than 1% of all uterine fibroids. Their atypical location leads to distortion of pelvic anatomy and frequent misdiagnosis as adnexal or ovarian tumors. Even advanced imaging modalities may fail to clearly identify the site of origin, creating significant diagnostic and surgical challenges.
Case Presentation: We reported a case of a giant broad ligament leiomyoma initially suspected to be an adnexal tumor. A 40-year-old multiparous woman presented with progressive abdominal distension and pelvic discomfort. Imaging revealed a 12 × 10 cm adnexal mass suspicious for ovarian pathology. Exploratory laparotomy identified a right broad ligament leiomyoma, which was successfully excised with preservation of the uterus and adnexa. Histopathology confirmed a benign leiomyoma with degenerative changes. The postoperative course was uneventful, and follow-up showed no recurrence.
Conclusions: Broad ligament leiomyomas should be considered in the differential diagnosis of adnexal masses, especially when imaging findings are inconclusive. Despite advances in radiologic evaluation, definitive diagnosis is often achieved intraoperatively. Awareness of this entity is essential to avoid misdiagnosis, prevent unnecessary radical surgery, and ensure careful intraoperative identification of displaced structures such as the ureter; surgical excision provides an excellent prognosis.