BACKGROUND: Uterine Leiomyoma (UL) is the most common mesenchymal benign tumor associated with several clinical symptoms and elevated number of hysterectomies. The recent stratification of UL, according to recurrent and mutually exclusive genomic alterations affecting HMGA2, MED12, FH and COL4A5-COL4A6, pointed out the involvement of distinct molecular pathways. However, the mechanisms of regulation involving these drivers are poorly explored. METHODS: A total of 78 UL and 34 adjacent normal myometrium (NM) tissues was collected from 56 patients who underwent hysterectomies at a single institution. Gene expression profiling was evaluated from fresh frozen tissues and compared with MED12 mutations at exon 2. In addition, RT-qPCR was applied to evaluate the expression levels of HMGA2 and their predictive miRNA regulators: hsa-let-7a, miR-26a, miR-26b, mir-93 and mir-106b. RESULTS: An unsupervised hierarchical clustering analysis revealed two main clusters with one of them (26 of 42 UL) showing an enrichment of MED12 mutated cases (18 of 26 UL). Increased expression levels of HMGA2 were observed in both clusters, including cases with MED12 mutation (cluster 1: 18 UL). The analysis of RT-qPCR revealed a significant HMGA2 overexpression (p<0.001) in UL in comparison with NM. Five miRNAs predicted to regulate HMGA2 were significantly downregulated (p<0.001) and negatively correlated to HMGA2 expression levels (P<0.05) in UL. CONCLUSION: HMGA2 overexpression was detected in a significant number of MED12 mutated UL, suggesting that these alterations can coexist. Furthermore, five miRNAs were pointed out as potential regulators of HMGA2 expression in UL.