A large degenerated fibroid may give a false impression of other abdominal gynecological abnormalities like in our case of a 46-year-old para 3, living 3 (P3L3) woman presented to our hospital with the complaint of distension of abdomen since last ten years. The increase in the size of the abdomen was slow initially, but it increased rapidly in last one month. She complained of right abdominal pain for the last one month along with difficulty in breathing and constipation. Abdomen examination revealed a huge abdominopelvic mass and a provisional diagnosis of the ovarian cyst was made clinically. Computed tomography (CT) scan showed a very large cystic lesion arising from the pelvis filling up the abdominal cavity. We planned for laparotomy and proceed. Intraoperatively, a giant cyst occupying the whole abdomen identified and control suction done with removal of ~5 liters of straw-colored fluid. The cyst was found to have adhered to the mesentery and also attached to the fundal area of the uterus. The cyst was severed from the uterus by clamping and cutting the pedicle of the cyst. Uterus and bilateral ovaries were looking normal. Total abdominal hysterectomy with bilateral salpingo-oophorectomy done. Cyst separated from guts and excised. Feeding vessels were from the mesenteric artery. Histopathological examination showed the features of leiomyoma with cystic degeneration. Leiomyoma with cystic degeneration is the rare secondary changes. But they can cause a diagnostic dilemma by mimicking huge ovarian cyst.
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