Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 11 3 2026 09 28 143 148 Azam Zafarbakhsh Department of Female Pelvic Floor Medicine and Surgery, Isfahan University of Medical Sciences, Isfahan, Iran. AND Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran. Azar Naeimi Reproductive Sciences and Sexual Health Research Center, Department of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran. Noushin Hosseini Department of Obstetrics and Gynecology, Isfahan University of Medical Sciences, Isfahan, Iran. 2026 06 21 2026 08 02 Disseminated peritoneal leiomyomatosis (DPL) is a rare benign condition characterized by multiple smooth muscle nodules throughout the peritoneum. We report a 36-year-old woman presenting with vaginal bleeding and a large pelvic mass. Preoperative MRI raised concern for malignancy, including leiomyosarcoma. Surgical and histopathological evaluation, however, revealed a benign uterine leiomyoma, an ovarian fibroma, and multiple omental smooth muscle nodules consistent with DPL. Notably, the patient had no history of prior uterine morcellation. This case underscores the importance of histopathological and immunohistochemical confirmation to differentiate DPL from malignant processes, preventing overtreatment and guiding appropriate management.  https://crcp.tums.ac.ir/index.php/crcp/article/view/1210 https://crcp.tums.ac.ir/index.php/crcp/article/download/1210/796