Ovarian leiomyoma: diagnostic challenges and imaging characteristics in a rare case.

Ovarian leiomyoma is an extremely rare benign tumour often diagnosed incidentally due to its nonspecific clinical and radiologic features. We present the case of a 48-year-old woman with progressive lower abdominal pain, distention, and genitourinary complaints. Imaging revealed a large complex adnexal mass with both solid and cystic components, seen on ultrasound, CT, and MRI, raising suspicion for a neoplastic process. Despite the use of multiple imaging modalities, definitive diagnosis required histopathological confirmation following surgical resection, which revealed an ovarian leiomyoma with cystic and myxoid degenerative changes. This case underscores the importance of considering ovarian leiomyoma in the differential diagnosis of adnexal masses and highlights the complementary roles of imaging and histopathology in achieving an accurate diagnosis and guiding appropriate management.