Abstract
Leiomyosarcoma, a rare malignant mesenchymal tumor originating from smooth muscle, comprises a small proportion of all ovarian malignancies and presents as an aggressive ovarian tumor. This case report presents a 56-year-old postmenopausal woman diagnosed with ovarian leiomyosarcoma (OLMS). The patient presented with chronic pelvic pain, abdominal distension, and metrorrhagia. Physical examination revealed a 12 cm pelvic mass in the right adnexal region. The surgical intervention included total hysterectomy with bilateral adnexectomy, bilateral pelvic and para-aortic lymphadenectomy, and total omentectomy, confirming leiomyosarcoma via histopathological analysis. The literature review underscores the absence of established pathogenesis for primary ovarian leiomyosarcoma (POLMS), highlighting diagnostic challenges due to the lack of specific tumor markers and ambiguous imaging results. Despite aggressive management, POLMS exhibits a poor prognosis for advanced tumors. Given the rarity of reported cases and the limited understanding of optimal management strategies, this report seeks to improve knowledge of the diagnostic challenges and therapeutic approaches for OLMS, emphasizing its atypical presentation and treatment considerations.