A primary fistula connecting a broad ligament leiomyoma to the cervix.

The endocervico-myomatous fistula is a rare condition that has been reported as a complication following uterine artery embolization. To date, no primary case of this nature has been documented in the PubMed database. The objective of this study was to present the diagnostic and therapeutic approaches for a primary fistula connecting a broad ligament leiomyoma to the cervix. A 35-year-old woman with vaginal bleeding, transvaginal ultrasound revealed features initially interpreted as a bicornuate unicollis uterus according to the ASRM 2021 classification, with 2 distinct uterine cavities communicating with a single cervix. The hysteroscopy revealed a prominent cavity on the left side of internal os of the cervical canal containing aged clots and mucus. The patient underwent laparoscopic resection of the pelvic lesion, subsequent surgical findings confirmed this to be a broad ligament leiomyoma with fistula formation rather than a true Müllerian anomaly. The postoperative pathology revealed the presence of leiomyoma with hyaloid degeneration. The patient had uneventful postoperative recovery. This case underscores the rare presentation of a broad ligament leiomyoma with fistula formation as a differential diagnostic consideration for bicornuate unicollis uterus in gynecological ultrasonography. A systematic literature review revealed no analogous reports, highlighting the uniqueness and instructional value of this case.