Giant Ovarian Leiomyoma Presenting With Unusual Lower Limb Weakness and Paresis: A Case Report

ABSTRACT Ovarian leiomyomas are rare, benign tumors accounting for 0.5%–1% of all benign ovarian neoplasms, typically presenting asymptomatically or with nonspecific symptoms such as abdominal pain. Neurological symptoms, such as lower limb weakness and paresis, are exceptionally rare and have not been previously reported as primary manifestations of ovarian leiomyoma. A 64‐year‐old postmenopausal woman presented with progressive lower limb weakness, paresis, and urinary incontinence over 3 months, initially suspected to be a recurrent stroke. Neurological examination and carotid Doppler were normal, ruling out stroke. Abdominopelvic imaging revealed a 49 × 34 × 14 cm mass originating from the left ovary, causing lumbosacral nerve root compression. Laparotomy with total abdominal hysterectomy and bilateral salpingo‐oophorectomy was performed. Histopathology confirmed a benign ovarian leiomyoma. Postoperative complications, including renal failure and bilateral pleural effusions, led to the patient's demise on day 6. This case represents the first reported instance of a giant ovarian leiomyoma presenting with neurological symptoms due to lumbosacral nerve compression. Clinicians should consider ovarian leiomyomas in the differential diagnosis of pelvic masses with atypical neurological presentations and pursue MRI or lumbosacral imaging for accurate characterization.