Leiomyomas of the uterus are extremely common neoplasms. The overall incidence ranges between 4% and 11% and rises to nearly 40% in women’s over the age of 50 years. Among smooth muscle lesions uterine leiomyomas (uterine fibroid) are most common followed by adenomyosis of myometrium METHODOLOGY This study consists of 517 hysterectomies cases collected over a period of 2 years from June 2008 to June 2010 (2 years prospective study). The material was obtained from the patients admitted to district hospital in a tertiary care teaching hospital. Detailed micro-anatomic features were studied and recorded RESULTS AND OBSERVATION During the two-year study period, out of 517 hysterectomy cases, the study includes histopathological proved 276 cases with myometrial lesions. Youngest was 20 years old and oldest was 65 years old. Menorrhagia was the commonest presenting symptom seen in 99 patients followed by dysmenorrhea in 49 patients, white discharge per vagina 33 patients and mass per vagina in 53patients . Histologically non-neoplastic lesions in the form of adenomyosis was seen in 52 uteri (18.84%). Pure leiomyoma was diagnosed in 156 specimens (56.18%), whereas other 67 leiomyomas were associated with adenomyosis (24.27%). CONCLUSION Histopathological study of myometrial lesions includes adenomyosis and variety of leiomyomas classified based on site, size and microscopic variants. Although benign and malignant lesions of are distinct and well studied, there are some benign lesions that often mimic cancer-causing diagnostic dilemma.