The diagnosis of uterine smooth muscle tumours is usually not difficult. Occasionally, benign tumours with an unusual histopathology may cause some dilemma for clinicians who had not experienced such report before. A 50-year-old female patient was admitted to our gynaecology clinics with lower abdominal heaviness and urinary symptoms and undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy with a probable diagnosis of cervical fibroid. Histopathological examination showed lipoleiomyoma uterus with focal symplastic features. This case report describes the clinic-pathological dilemma in managing the patient with symplastic leiomyoma of the uterus.