A 78-year-old female had been generally well with no known chronic medical conditions and was taking no medications when she presented to her primary care physician with lower abdominal pain and urinary frequency of one month's duration. Physical examination at the time revealed a well-appearing woman with normal vital signs and no abnormal physical findings except a palpably enlarged uterus by bimanual pelvic examination. CT scan confirmed the presence of a uterine mass suspicious for malignancy. She was referred to a gynecologic oncologist and had a total abdominal hysterectomy and salpingo-oophorectomy with partial infracolic omentectomy and pelvic debulking of what appeared to be a large (15 cm) tumor mass. Final pathology was high-grade leiomyosarcoma with microscopic invasion of the colon and bladder.