Background Uterine mesenchymal tumors have been conventionally classified into two broad categories; Smooth Muscle Tumors (SMT) and Endometrial Stromal Tumors (EST). Most common being Smooth muscle tumors, its accurate categorization by light microscopic examination is important and at times can be challenging. Here we discuss Institutional experience of Uterine mesenchymal tumors for 1 year in a tertiary care centre in South India. Aim To determine the various histomorphological types of Uterine Mesenchymal Tumors and to study its correlation with Clinico-Pathological findings. Materials and Methods It is a descriptive record based study. Study was carried out in a tertiary care centre in South India. All the consecutive hysterectomy and myomectomy cases received in the department of Pathology were studied. Cases from women aged between 20-80 years, received from January 2019 to December 2019 and diagnosed as mesenchymal tumors of the uterus were retrieved and reviewed. Results In our study period of 12 months, a total of 246 cases were noted. There were 212 Hysterectomy specimens and 34 Myomectomy specimens. Average size of the lesions was 4.9 cm and average age at presentation was 45yrs. Benign tumors were more common compared to malignant tumors. Out of total number of 246 cases, 243 were Leiomyoma and its variants. Typical leiomyoma were 179 cases and variants included Leiomyoma with hyaline change 34 cases, which was commonest followed by adenomyoma 11 cases, cellular leiomyoma 8 cases, leiomyoma with myxoid change 4 cases, lipoleiomyoma 2 cases, atypical leiomyoma 2 cases and leiomyoma with red degeneration and leiomyoma with amianthoid fibers 1 case each. Among malignant tumors 1 case was Leiomyosarcoma (LMS) and 2 were Endometrial Stromal Sarcoma (ESS). Conclusion It is important to differentiate benign and malignant mesenchymal tumors due to differences in their clinical outcome. Most common being Smooth muscle tumors, its accurate categorization by light microscopic examination is important and at times can be challenging. Role of surgical pathologist in making this distinction, especially in difficult cases cannot be underestimated. Although Immunohistochemical stains are helpful in establishing the final diagnosis, the morphologic features are superior to all the other ancillary techniques for this group of neoplasms. Recent application of molecular techniques has identified numerous lesions with distinctive genetic abnormalities and clinicopathological characteristics.

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