Currently, only about 10 cases with malignant transformation have been reported.[2,9–16] The risk factors for malignant transformation of LPD include no history of oral contraceptives, no history of pregnancy, no history of uterine leiomyoma, no expression of estrogen and progesterone receptors in leiomyomas nodules, and recurrence within 1 year after initial treatment.[9] For patients with high-risk factors, vaginal ultrasound and MRI should be scheduled to conduct a regular follow-up. Here, PGR is linked to leiomyoma.