Nearly 5% of all myomas are originated from the smooth muscle of uterus, beneath the endometrium and called as submucous myoma. Submucous myomas distort the cavity when they enlarge and may even pass the cervix and reach to the vagina by uterine contractions. The most common treatment of the myomas prolapsing the vagina is the vaginal myomectomy. However, abdominal treatment may be necessary when the submucous myom grow within the cavity and enlarge the uterus. This paper presents a case of huge submucous myoma with a suspician of leiomyosarcoma in the magnetic resonance imaging, that grow into very big size within the cavity and completely fill the vagina. A 45-years-old multiparous women with a complaint of vaginal bleeding was diagnosed to have a 8 cm necrotic submucous myoma prolapsed into vagina after pelvic examination with speculum. Due to the combination of malignancy risk and uterus with three-
month gravida size, abdominal exporation with laparotomy was planned for the patient. In the abdominal exploration, a 14*13*12 cm submucous myoma growing into the endometrial cavity was observed and abdominal hysterectomy was planned.
After completion of abdominal hysterectomy, vajinal part of myoma was tried to extract abdominally but it could not. Due to the complete replacement of vaginal cavity by the myoma, vajinal part of myoma can only be extracted by vaginal approach.