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Introduction Leiomyomas are the most common benign smooth muscle tumours of female reproductive tract, with incidence of 25%. However, Large leiomyomas with cystic degenerations can mimic abdominal malignancy and challenge the radiologist and the operating surgeon. Aims and Objectives We aim to highlight the rare presentation of a giant leiomyoma mimicking neoplastic tumors of abdomen, emphasizing the diagnostic challenges encountered , and importance of clinical suspicion, along-with surgical exploration and histopathology being the final verdict in delineating the etiology. Case A 28 year unmarried female presented with AUB and abdominal distension since 3 months. She had undergone myomectomy elsewhere 9 years back, with histopathology showing low grade uterine sarcoma, without any follow up. Clinical examination revealed firm abdomino-pelvic mass corresponding to a 36-week uterus. Ultrasound depicted heterogeneously hypoechoic mass(11*20*19 cm) with calcification and tortuous vessels, of right ovarian origin. But MRI revealed the mass encasing pelvic organs and iliac vessels with invasion into the posterior myometrium ; D/d being uterine sarcoma / aggressive angiomyxoma. Apposite referrals taken and patient was operated. Discussion This case presents a diagnostic dilemma encountered in a young woman presenting with a complex abdominopelvic mass .It was initially suspected to be a malignant ovarian tumor or uterine sarcoma due to its extensive involvement of pelvic organs, and abdominal vessels. However, surgery proved it otherwise, with histopathological analysis revealing a giant leiomyoma with cystic and hyaline degeneration due to spindle cell morphology, being positive for SMA and Desmin. Despite its aggressive imaging features, the absence of capsular breach and malignancy markers suggested a benign aetiology. Conclusion Giant leiomyomas with cystic degeneration may present diagnostic difficulties in differentiating from ovarian / abdominal malignancies even on ultrasound and MRI. Though this differential diagnosis must be considered prior to surgical management, exploration with histopathology remains the final cornerstone in clinching the diagnosis.