Parasitic leiomyoma is a benign solid tumor formed by ectopic implantation of uterine fibroids,and it is rarely associated with ascites and elevated carbohydrate antigen 125(CA125).This case reported presents a rare instance of parasitic leiomyoma,which was complicated by massive ascites and significantly elevated CA125 levels.Imaging examination suggested a large adnexal mass and multiple nodules in the pelvic-abdominal cavity,leading to a preoperative misdiagnosis of ovarian malignancy with peritoneal metastasis.The patient's symptoms were alleviated,and CA125 levels returned to normal following surgical treatment.This case highlights the importance of thoroughly considering the patient's surgical and medication history,along with a comprehensive evaluation that includes tumor markers,pelvic-abdominal MRI,ascitic fluid biochemical and cytological analysis,and intraoperative frozen section pathology,in order to avoid misdiagnosis.