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Introduction: Uterine leiomyosarcoma is a rare, aggressive malignant tumour of the uterus, representing less than 1% of all uterine neoplasms. Diagnosis is confirmed after surgery. Aims and Objectives: The study reports analyses three cases of uterine leiomyosarcoma diagnosed after surgery. The objectives were to review the clinical presentation, discuss the diagnostic challenges and evaluate the treatment outcomes and prognostic factors of uterine LMS when diagnosed after surgery. Materials and Methods: Three cases diagnosed with uterine leiomyosarcoma at our institution between 2023 and 2024 were studied. All patients presented with symptoms such as abnormal uterine bleeding, pelvic pain and mass per abdomen. Initial diagnosis varied, and the patients underwent surgery based on the suspected diagnosis. Histopathological analysis after surgery confirmed uterine leiomyosarcoma in all the cases. The clinical data including demographics, imaging findings, surgical details, and follow-up outcomes were reviewed and analysed. Results: The mean age of the patients were 50 years. All three women were postmenopausal. Case 1 diagnosed as uterine fibroid, underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Case 2 diagnosed as ovarian malignancy, underwent staging laparotomy (including total abdominal hysterectomy with bilateral salpingo-oophorectomy). Case 3 diagnosed as endometrial carcinoma, underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, infracolic omentectomy, and bilateral pelvic lymphadenectomy. Postoperative histopathological study confirmed uterine leiomyosarcoma in all three cases. Conclusion: Uterine leiomyosarcoma is a challenging diagnosis, often only identified after surgery. Despite preoperative imaging, malignancy may go unrecognized because its features can mimic those of other conditions. This case series emphasizes the importance of heightened clinical awareness and the challenges in diagnosing uterine leiomyosarcoma.