Primary Ovarian Leiomyoma with Torsion in a Postmenopausal Woman: A Rare Case with Progesterone Receptor Positivity

Ovarian leiomyomas are rare benign smooth muscle tumors, accounting for <1% of all ovarian neoplasms. While most commonly found in premenopausal women, their occurrence in postmenopausal women is rare and often raises concerns about malignancy. We report a unique case of ovarian leiomyoma torsion in a 73-year-old postmenopausal woman who presented with postmenopausal bleeding and acute pelvic pain. Imaging studies initially suggested an ovarian mass and surgical exploration revealed a twisted mass, which was histologically confirmed as a leiomyoma. Immunohistochemical analysis of the tumor demonstrated strong positivity for progesterone receptors, suggesting a potential role for progesterone in the tumor's growth, even in a postmenopausal setting. This case highlights the diagnostic challenge of ovarian leiomyomas in older women and underscores the importance of histopathological examination, including immunohistochemistry, to guide management and provide insights into the potential hormonal influence on tumor development.