Uterosacral ligament fibroid: a rare occurrence yet a major diagnostic challenge

Fibroid is a common benign neoplasm more often located in the uterus and less commonly seen adnexa other supporting structures of like broad uterosacral ligament. The incidence extra uterine leiomyomas <1%. A 48-year-old female para one live presented with chief complaints mass per abdomen for 2 years prolonged heavy bleeding 15 days. Based on clinical radiological findings, diagnosis tubo-ovarian was made. patient underwent staging laparotomy. However, intraoperatively, she diagnosed ligament fibroid size approximately 40×45 cm. Total abdominal hysterectomy bilateral salpingo-oophorectomy done. There no associated complication. Histopathology confirmed to be leiomyoma. Uterosacral encountered very rarely. Our case report intends bring light necessity keeping various possible locations leiomyoma mind considering adnexal as an important differential vice-versa before operating. Leiomyoma confused ovarian or posing diagnostic difficulty gynaecologist well radiologist thereby challenge operating surgeon while performing surgery.