Benign tumour of the muscular uterine wall is known by various names such as Leiomyomata/ myxoma/ fibroid [1]. Most of them are detected in middle aged women and are uncommon in women less than thirty years of age [2]. The overall incidence is between 4% and 11%, but it rises to nearly 40% in women over the age of fifty years. Clinically apparent lesions are less common in parous and premenstrual women [3].

The symptomatology may vary based on the location mainly [2]. It ranges from asymptomatic to various menstrual disturbances and even urinary difficulties. They are known to shrink after menopause and it is associated with fibrosis and reduction in individual tumour cells [4, 5]. The frequency does not decrease after menopause [2]. The normal myometrium of leiomyoma containing uterus expresses high level of oestrogen receptors, a fact that may be related to their pathogenesis [6]. The ovarian follicular hormone acts upon myometrium and results in cellular metaplasia with subsequent development of uterine fibroids [7].

Symptomatic leiomyomas need urgent attention by myomectomy in younger females whereas hysterectomy still remains the traditional modality of treatment [8, 9]. The intent of this voluminous study is to estimate the prevalence of uterine leiomyomas, among the hysterectomy specimens received in a rural population setup in the State of Tamil Nadu. This study also analyses the leiomyomas in context to various individual characteristics like age, location, number, clinical presentation as well as some combined parameters that include location and number, location and clinical presentation. To the best of the author’s apprehension such an extensive study involving a rural population in the state have not been done previously. Hence it is being presented as an account of its rarity.

Study place: The study is conducted in Department of Pathology, Rajah Muthiah Medical College and Hospital, Chidambaram.

Study type: This is a retrospective study.

Study duration: The study duration was for twenty-five years from January 1988 to December 2012.

In the present study 61% of the patients presented with menstrual disturbances with menorrhagia being the most common symptom.

Table-3: Leiomyomas: age distribution

In the present study, majority were intramural leiomyoma (73.07%) followed by subserosal (14.75%) and submucosal (12.16) leiomyoma (Table-4). The five-year interval study showed a gradual decline in intramural leiomyoma while submucosal and subserosal were slightly increasing as the years passed by (Table-5).

Table-4: Fibroids - location

Table-5: Fibroids - Location (5 Year Interval)

The present study showed 902 cases having only one leiomyoma while 298 cases were found to have more than one leiomyoma among which majority were within single anatomical location while some were seen in combination with other anatomical locations (Table-6). The most common combination seen was intramural with subserosal followed by intramural with submucosal. The number of leiomyomas in context to the location was shown in Table-7.

Table-6: Leiomyomas – solitary vs multiple

Table-7: Leiomyomas-location and number

Figure-3: Submucosal leiomyoma

Figure-4: Intramural and Subserosal

Hysterectomy, one of the major gynaecological surgery, was first performed in the year 1843 in England by Charles Clay [10]. Inspite of the availability of medical and conservative management, hysterectomy remains the second most frequently performed obstetric surgery after caesarean section in many parts of the world [11]. The commonest indication for hysterectomy is Leiomyoma [12]. Leiomyoma is a benign neoplasm composed of smooth muscle cells in a variable amount of fibrous stroma [13].

Sometimes uterine fibroids can undergo spontaneous regression [23].

Fibroids increase in size during pregnancy and the maximum increase occur before the 10th week of gestation [24]. Submucosal leiomyomas are a possible cause of infertility and are highly amenable to surgical treatment and subsequent restoration of fertility [25]. In the present study the lesions were most commonly seen in 41-50 years age group (44.20%) which is comparable with studies by Rosario Pinto (44.7%), [26] Usha et al (48.95 %), [27] Ramesh (49.37) [28] and Mangala gowri [29] (Table-8). The most common clinical presentation in the present study was menstrual disturbances (61%) and its comparable with Poddar (55.9%), [30] Bhaskar Reddy (59%) [31] and Chhabra et al (63%) [32] (Table-9).

Table-8: Leiomyomas-age incidence.

Table-9: Leiomyomas - clinical presentation.

The commonest location of fibroid in the present study was intramural (73.09) and it is comparable with Rosario Pinto (73.5%), Usha et al (77.17%) and Maitri (60%) [33] (Table-10).The number of leiomyomas occurring as a single mass was more common in the present study (75.29%) and it’s comparable to Rosario Pinto (56.1%) and Mangala gowri (71.1%) (Table-11) but in contrast to a study by Begum S et al [34] whose study had majority of multiple leiomyomas. When present as multiple leiomyomas, most of them were located within a single anatomical location but some of them were present as a combination with Intramural and subserosal being the most common one in the

Hence a large-scale study like this will help to know the demographical and clincopathological trends in the locality and thereby add to the existing volume of knowledge regarding uterine leiomyomas.

This extensive study casts light on the gamut of female genital tract neoplasms with special context to uterine leiomyomas presenting in a rural teaching hospital in Tamil Nadu. It also revealed how widespread the uterine leiomyomas were in the rural parts in and around the teaching institute.

Dr. Gowri Sankar Ramalingam: Contributed in collecting the data, compiling it and preparing the manuscript. Dr. Anbu Lenin Kulandaivel: Author helped in editing the manuscript and final review.

Dr. B. Krishnaswamy & Dr. P. Viswanathan: Authors contributed by helping in retrieving some data’s and approving the final version. All the four authors read and approve the final version of the manuscript.