Where does it come from? A large pelvi-abdominal mass with points to ponder

Ureteral leiomyosarcoma is a very rare aggressive retroperitoneal malignancy with limited possibility of an accurate pre-operative diagnosis. Incidence of ureter leiomyosarcoma is extremely rare. Hence, there is paucity of reported cases in the literature. We present a case of a 60-year-old postmenopausal woman presenting with abdominal distension and discomfort. This was initially reported as a malignancy arising from left ovary, as the lesion had apparent convergence toward left adnexal region and the left ovary was not seen separately. In addition, there was moderate hydronephrosis of the left kidney and left ureter was not separately made out from the lesion. Leiomyosarcoma should be considered as a differential diagnosis in cases of ureter stricture and retroperitoneal tumors causing ureteric obstruction.