A 39-year-old woman gravida 0, para 0 presented to our surgical department with a 4-month history of progressive constipation, increasing abdominal size, back pain, vague abdominal pressure sensations and urinary frequency. At admission, she stated that she was pregnant and this child was “a gift from God’’. Medical history revealed several hospitalizations due to mental illness. Blood tests and gynecological consultation excluded pregnancy. Physical examination revealed a 36-week-sized uterus (Figure 1). Transabdominal ultrasound and computed tomographic scanning suggested a giant abdominopelvic mass without ascites, metastases, or enlarged pelvic or para-aortic lymph nodes. After psychological support, the patient consented to surgical treatment. An exploratory laparotomy with a midline incision revealed a giant mass that protruded from the incision (Figure 2). Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy was performed (Figure 3). Macroscopically, the specimen was a 28.1 kg uterine leiomyoma measuring 62×39×21 cm (Figure 4), well circumscribed, with solid nodules that were white or tan, with a whorled appearance on histological cuts. The postoperative course was uneventful and the patient was discharged on the 10th postoperative day.Figure 3Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy.View Large Image Figure ViewerDownload (PPT)Figure 4The 28.1 kg uterine leiomyoma measured 62×39×21 cm.View Large Image Figure ViewerDownload (PPT) By definition, giant uterine leiomyomas weigh more than 11.4 kg and are very rare. They represent a great diagnostic and therapeutic challenge because of the often atypical presentation and the possibility of underlying malignancy, mainly leiomyosarcoma. A history of growing abdominal mass, back pain, and urinary disturbances is almost universally present. Imaging such as computed tomography and magnetic resonance imaging, along with evaluation of tumor markers, can provide clues for the histological status of the tumor. Because there is potential for underlying malignancy, the treatment of choice is transabdominal hysterectomy with bilateral oophorectomy.