Cotyledonoid dissecting leiomyoma of uterus is an unusual variant of uterine leiomyoma that presents with an alarming gross appearance. We report a case of cotyledonoid dissecting leiomyoma in a 36 year old, 35 weeks pregnant lady who presented with lower abdominal pain. On caesarian section, two fungating polypoidal masses (mistaken for placental tissue), arising from the anterior and anterolateral surfaces of uterus, were excised. Macroscopy revealed multiple bulbous congested nodules connected by fibrous tissue. Microscopy showed benign smooth muscle cells arranged as micronodules with prominent perinodular hydropic degeneration and rich vasculature. There was no cellular atypia, increased mitosis or necrosis. It is important to recognize this rare variant of leiomyoma to prevent overtreatment.
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