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Introduction: Renal leiomyoma is a rare renal tumor that originates from smooth muscle. Among all existing benign renal tumors, leiomyoma is one of the least common benign renal tumors., Case Presentation: We report of a case report of a 43-year-old male complaints of palpable mass on the upper left abdomen, abdominal discomfort and hematuria. Contrast-enhanced CT scan revealed a solid heterogenous mass on the left kidney, adherent to the left abdominal wall and pushed the spleen cranially. Patient underwent radical nephrectomy and histopathology results revealed leiomyoma. Two weeks after surgery, the patient was asymptomatic., Discussion: Imaging of renal leiomyoma may provide a clue with a general finding of a well-defined tumor margin and no local invasion. In our case preoperative CT findings made the initial diagnosis inconclusive since it showed the renal mass was adherent to the abdominal wall. Definitive diagnosis was only possible through histopathologic examination., Conclusion: Radical nephrectomy remains as the mainstay of treatment in inconclusive preoperative diagnosis., Competing Interests: Conflict of interest statement None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)