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**"A Giant Cystic Leiomyoma Masquerading As An Ovarian Malignancy"**.-An Interesting Case Report. Introduction: - **Leiomyomas**, also known as fibroids, are common uterine neoplasms found in 20?30% of reproductive-age women. - While typical leiomyomas are easily identified via imaging, degenerative changes can lead to diagnostic confusion. Case Report: - **Patient:** A 48-year-old woman with abdominal distension for three months, accompanied by abdominal pain. - **Clinical Examination:** Mild pallor, a uterus enlarged to about 16 weeks of gestation, healthy cervix and vagina, and no tenderness. - **Imaging (CT scan):** A large, complex cystic lesion (21.8 cm ? 13.8 cm) in the midline, suspected to be an ovarian mass. Surgery and Findings: - **Intraoperative Findings:** A 15 ? 15 ? 20 cm cystic mass adhered to the uterine torus and the cervix. - A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Results: - **Histopathology Examination (HPE):** Revealed the mass was a cystic degeneration of a fibroid. Conclusion: - Cystic degeneration of fibroids, though rare (occurring in only 4% of leiomyomas), should be considered in the differential diagnosis of pelvic masses. - Advanced imaging techniques like CT and MRI are critical in evaluating such cases due to their atypical presentations.