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Histogenesis of uterine leiomyosarcoma has been controversial. It is generally believed that uterine leiomyosarcomas arise de novo, rather than from any precursor lesions. We report an unusual case of spontaneous rupture of leiomyosarcoma arising in pre-existing calcified uterine leiomyoma, which has been monitored over the years after menopause. This case also suggests that spontaneous intraperitoneal hemorrhage associated with malignant transformation of uterine leiomyoma, although rare, should be considered in postmenopausal women presenting with rapid growing uterine mass.

Spontaneous Uterine Perforation Secondary to Leiomyosarcoma Arising in a Uterine Leiomyoma