• Usually in or immediately adjacent to falciform ligament or ligamentum teres (Am J Surg Pathol 2000;24:1239)
• Usually indolent behavior

• Usually females, median age 11 years, range 3-21 years

• 12 year old girl with malignant tumor of broad ligament (Virchows Arch 2006;448:867)
• 46 year old woman with sudden onset of severe abdominal pain (J Med Case Rep 2011;5:383)

• Median 8 cm, range 5-20 cm

• Fascicular or nested groups of spindle cells (usually no epithelioid cells) with lightly eosinophilic, fibrillar cytoplasm with cytoplasmic clearing and small but distinct nucleoli in delicate capillary network similar to renal cell carcinoma
• Rare mitotic figures
• No necrosis, no angiolymphatic invasion

• HMB45 (100%), MelanA (50%), microphthalmic transcription factor (50%), smooth muscle actin (50%), myosin (50%)

• Desmin, S100

• Angiomyolipoma: thick walled blood vessels, lipid distended tumor cells, spindled cells
• Cellular schwannoma: true capsule, thick-walled hyalinized blood vessels, strong S100 staining
• Clear cell sarcoma of tendons and aponeuroses: epithelioid and spindled areas with tumor giant cells, S100+, positive for melanocytic markers but negative for smooth muscle actin and myosin; t(12,22) present
• Leiomyoma: distinctly eosinophilic, cigar-shaped nuclei with blunt ends and perinuclear vacuoles; thick walled blood vessels
• Leiomyosarcoma: large deep seated mass with obvious nuclear pleomorphism and mitotic activity, often with necrosis; negative for HMB45, MelanA, microphthalmic transcription factor, positive for desmin

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