Deciphering a diagnostic enigma from ovarian malignancy to disseminated peritoneal leiomyomatosis

Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disorder of uncertain aetiology that often mimics advanced ovarian or peritoneal malignancy, both clinically and radiologically. The majority of reported cases have been associated with prior laparoscopic uterine myomectomy, particularly when uncontained morcellation was used. Here, we present a case of a nulliparous woman in her 20s who presented with a large abdominopelvic mass and radiological findings suggestive of ovarian carcinoma. However, further history-taking revealed a laparoscopic myomectomy with morcellation performed 2 years earlier for primary infertility due to a large intramural fibroid. Subsequent ultrasound-guided biopsy and immunohistochemistry confirmed the diagnosis of disseminated peritoneal leiomyomatosis (DPL). The objective of this case report is to highlight the diagnostic challenge DPL poses by mimicking malignancy and to emphasise the importance of eliciting prior surgical history—particularly involving morcellation—as a crucial clue in correctly identifying this benign entity.