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ABSTRACT: There are limited reports in the literature about Bartholin's gland leiomyoma, mainly due to its rare occurrence. This case report describes a 56-year-old woman presenting with a lump in her vulva. The initial suspicion was that of a Bartholin's gland carcinoma based on her clinical signs and symptoms. The mass was excised and the histopathology report described a leiomyoma. Differentiating between benign and malignant tumors by inspection alone can pose a diagnostic dilemma. There are no clear management guidelines but some authorities recommend that enlarged Bartholin's gland in postmenopausal women should be completely excised so as to exclude adenocarcinoma of the gland. However, other case reports and reviews have tried to justify an initial biopsy before considering complete excision to avoid unnecessary intervention in women whose biopsy confirms a benign lesion. In the case described, surgical excision was necessary and beneficial to the patient to provide symptom control.