uterine fibroids are the most common uterine neoplasm of uterus and the female pelvis and the most common indication for hysterectomy as well .
when the tumor fills the whole pelvis or is pedunculated , there is always an uncertainty regarding the uterine or ovarian origin of the tumor .
a cervical fibroid especially with degenerative changes mimics an ovarian tumor and causes a clinical dilemma .
a 40-year - old woman , p 2 living 2 , presented in the department of gynaecology with the complaint of progressively increasing distension in abdomen for last 1 year .
surprisingly , there were no complaints regarding change of menstrual pattern , urinary or bowel habits , anorexia or fever . on examination , a huge abdominal mass occupying whole of the hypogastrium , both iliac fossa , umbilicus , and left hypochondrium ,
the mass was 10  8 inches in size , smooth surfaced with regular margin , soft to firm in consistency , nontender , side to side mobile , lower limit not reachable , and engaged in the pelvis more toward the left side .
the same mass was felt obliterating all the fornices ; uterus was easily palpable of normal size but dextro deviated .
ultrasonography revealed a huge complex mass arising from the pelvis and extending into the abdomen occupying almost whole of the abdomen with well - defined margins ; complex internal echotexture , predominantly echogenic with multiple poorly hypoechoic areas along with two cystic areas , each measuring around 4 cm  5 cm in size .
a normal size uterus was seen pushed to the right side with normal central endometrium .
clinically provisional diagnosis of the benign ovarian tumor was made based on doppler and biomarker ca 125 levels .
after preanesthetic work up , the patient was taken up for laparotomy . per operatively soft mass of size 12 
10 inches with intact external capsule was seen , growing into the leaves of left broad ligament and extending above the umbilicus .
both ovaries , right tube and uterus was normal but left fallopian tube was stretched over the mass .
on opening the broad ligament leaf , it was found to be arising from posterior surface of upper part of cervix .
mass was shelled out followed by total hysterectomy with left - sided salpingo - oophorectomy [ figure 1 ] .
cut section showed few solid areas along with multiple cystic areas , one containing black tarry material suggestive of red degeneration .
surgical specimen showing normal uterus with huge cervical fibroid histopathology of the mass revealed benign spindle cell tumor ( leiomyoma uteri ) with red , cystic , myxoid and hyaline degenerations and dystrophic calcification [ figure 2 ] .
histology : spindle cells tumor ( leiomyoma ) with cystic , fatty , myxoid , and red degenerations
fibroids extending into broad ligament are rare and may mimic an ovarian tumor . it is known that degenerative changes result in unusual appearance that adds to diagnostic confusion .
pedunculated uterine , cervical , and true broad ligament fibroid , especially with degeneration , may be mistaken for lesion of ovarian origin and therefore must be kept in the differential diagnosis .
cervical fibroids pose enormous surgical difficulty by virtue of their relative inaccessibility and proximity to bladder and uterus and distorting the normal anatomical relationships . as in this case
it bulges outward between the layers of broad ligament , displacing uterine artery outward and upward and ureter outward toward the pelvic side wall .
 uterine fibroids are the most common uterine neoplasm of uterus and the female pelvis and the most common indication for hysterectomy worldwide . 
 when the fibroid is large and fills the whole pelvis or is pedunculated , it becomes difficult to differentiate from ovarian mass clinically . 
 cervical fibroids pose enormous surgical difficulty by virtue of their relative inaccessibility and proximity to the anterior bladder , posterior rectum , and distorting the normal anatomical relationship of pelvic structures . 
 a cervical fibroid especially with degenerative changes mimics an ovarian tumor and poses a clinical dilemma . 
 this case is also exemplified for its rarity and diagnostic difficulty . 