Background: Leiomyoma is the most common benign smooth muscle tumor of the uterus and represents one of the leading indications for hysterectomy in women of reproductive and perimenopausal age groups. Although commonly diagnosed clinically and radiologically, histopathological examination remains the gold standard for confirming diagnosis, identifying variants, and detecting associated secondary degenerative changes.

Aim: To evaluate the histopathological spectrum, variants, and secondary degenerative changes of uterine leiomyoma in hysterectomy specimens.

Materials and Methods: This descriptive cross-sectional study was conducted in the Department of Pathology, Sree Mookambika Institute of Medical science over a period of 18 months. A total of 60 hysterectomy specimens diagnosed with leiomyoma were included. Detailed clinical data were collected from pathology requisition forms and medical records. Gross and microscopic examinations were performed using routine Hematoxylin and Eosin staining. Histopathological variants, site of leiomyoma, and associated degenerative changes were analyzed statistically using SPSS software.

Results: The majority of patients belonged to the 41–50 years age group (46.7%). Menorrhagia was the most common presenting complaint (40%). Intramural leiomyoma was the predominant type observed in 63.3% of cases. Conventional leiomyoma constituted 73.3% of cases, while cellular leiomyoma, myxoid leiomyoma, and lipoleiomyoma were less frequent. Secondary degenerative changes were observed in 46.7% of cases, among which hyaline degeneration was the most common finding (26.7%).

Conclusion: Histopathological examination plays a crucial role in the accurate diagnosis and classification of uterine leiomyoma. Identification of histological variants and degenerative changes aids in better understanding of the disease spectrum and helps differentiate benign lesions from malignant smooth muscle tumors.

Keywords: Uterine Leiomyoma, Hysterectomy, Histopathology, Degenerative Changes, Leiomyoma Variants, Fibroid Uterus.