CASE REPORT: CLINICAL CHALLENGES IN THE MANAGEMENT OF PRIMARY AND RECURRENT BROAD LIGAMENT LEIOMYOSARCOMA—A COMPARATIVE SERIES OF TWO PATIENTS

Abstract

Background: Primary broad ligament leiomyosarcoma is an ultra-rare malignancy representing less than 1% of gynecological cancers. Due to its scarcity, standardized therapeutic guidelines do not exist.

Case Presentations: We report two distinct recurrent cases from our tertiary center (2021–2025). Case 1 involves a 28-year-old premenopausal female presenting with a giant 25 cm retroperitoneal mass causing severe hydronephrosis. During radical baseline excision, an accidental internal iliac artery laceration was successfully repaired. Following fertility preservation and chemotherapy, she developed a localized pelvic side wall recurrence three years later, successfully treated via R0 secondary cytoreduction and delayed hysterectomy. She remains in sustained complete remission as of May 2025. Case 2 describes a 64-year-old postmenopausal female whose primary tumor was extracted via fragmentation at a regional facility. Her early recurrence was radiologically misidentified as a benign postoperative lymphocele. This diagnostic delay allowed progression to extensive multi-visceral peritoneal carcinomatosis, requiring aggressive secondary multi-visceral debulking and bowel resection followed by gemcitabine-docetaxel chemotherapy.

Conclusions: Broad ligament leiomyosarcoma demands intact tumor extraction and negative margins. Clinicians must evaluate postoperative pelvic fluid collections with high suspicion to avoid misdiagnosing early recurrence. Complete secondary cytoreduction offers optimal local control.