title: Uterine Leiomyomas: An ENIGMA.
abstract: BACKGROUND
  Leiomyomas are benign tumors composed of smooth muscle cells and varying amounts of fibrous connective tissue commonly encountered in women of reproductive age group. Leiomyomas need hormonal milieu for their growth and maintenance. Unopposed estrogenic stimulation manifests as leiomyomas undergoing secondary changes, endometrial proliferation or hyperplasia, and other associated pathological findings.
  
  
  OBJECTIVE
  To study and analyze various histopathological changes within uterine leiomyomas in hysterectomy specimens. And also, to analyze the associated endometrial and adnexal structures pathology.
  
  
  METHODS
  A 4 years retrospective study from June 2010 to June 2014 conducted in the Department of Pathology and Obstetrics and Gynecology, ESIC Medical College and PGIMSR, wherein 820 hysterectomy specimens clinically diagnosed as uterine leiomyomas were subjected to histopathological examination and relevant clinical data were analyzed.
  
  
  RESULTS
  Leiomyomas occurred mostly in women aged 31-50 years (90.23%). Menorrhagia (49.36%) and pain abdomen (30.6%) were the chief clinical manifestations. Endometrial patterns commonly seen were proliferative and hyperplastic endometrium together accounting for 73.4% and dual pathology with adenomyosis was 29.1%. Four cases of tubercular etiology and a single case of granulosa cell tumor of ovary was noted.
  
  
  CONCLUSIONS
  Though hysterectomy is a routine procedure in the management of uterine leiomyomas, occasional cases of tumor or infective pathology may be missed. Therefore, histopathology is mandatory and conscientious quest must be done for confirmed diagnosis and ensuring optimal management.
authors.affiliation: Department of Pathology, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Telangana, India.
authors.forename: Kempula
authors.initials: K
authors.lastname: Geethamala
authors.affiliation: Department of Pathology, ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India.
authors.forename: Venkataramappa Srinivasa
authors.initials: VS
authors.lastname: Murthy
authors.affiliation: Department of Pathology, ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India.
authors.forename: Bangalore Ramalingiah
authors.initials: BR
authors.lastname: Vani
authors.affiliation: Department of Pathology, ESIC Medical College and PGIMSR, Bengaluru, Karnataka, India.
authors.forename: Sudha
authors.initials: S
authors.lastname: Rao
keywords: Endometrial changes; hysterectomy; leiomyomas