Background <p>Uterine leiomyomas are the most frequently encountered pelvic tumours in women and are often diagnosed withconfi dence based on clinical and imaging fi ndings. However, reliance on a presumptive diagnosis of uterineleiomyomas may create a diagnostic blind spot, as several benign and malignant gynecological neoplasms canclosely mimic leiomyomas. Distortion of pelvic anatomy, tumour degeneration, and overlapping radiological featuresmay obscure the true origin and biological behaviour of these lesions. We present a case series of three distinctfi broid mimickers that illustrate important diagnostic pitfalls and emphasise the need for a systematic approach topreoperative evaluation.</p> Case Presentation <p>We report a series of three patients initially diagnosed as having uterine leiomyomas on imaging. In the fi rst case, apresumed cervical fi broid was found intraoperatively to be a pedunculated ovarian mass, and histopathologyconfi rmed ovarian fi broma. In the second case, a lesion interpreted as a subserosal leiomyoma was identifi ed atsurgery as a right adnexal mass, with histopathology confi rming dysgerminoma. In the third case, a postmenopausalwoman with a presumed degenerated intramural leiomyoma was ultimately diagnosed with FIGO stage IBleiomyosarcoma on histopathology. These cases highlight the limitations of imaging, particularly in atypicalpresentations and when ovarian origin is not clearly established.</p> Conclusion <p>Fibroid mimickers should be considered when red-fl ag features are present, including postmenopausal status, rapidgrowth, heterogeneous or enlarging masses, and non-visualisation of the ovary. Careful clinical correlation,assessment of ovarian separability, appropriate tumour marker evaluation, and MRI with diff usion-weighted imagingin selected cases may improve preoperative assessment. Histopathology remains the gold standard for defi nitivediagnosis.</p>