Objectives leiomyosarcomas of the gynecological tract (LMS) consist a heterogeneous group of mesenchymal gynecological malignancies with unclear therapeutic recommendations and unspecific but poor prognosis since they usually metastasize and tend to recur very often, even in early stages.

Methods We retrospectively analyzed all female patients with LMS treated in our institution over the last 19 years. Clinicopathological data, treatments, and outcomes were recorded.

Results Data were retrieved from 16 women with a median age of 51 (range: 31–77) years, at diagnosis. Fifty percent of patients were in the menopause period. The mean symptom was bleeding, followed by pelvic pain. Ten patients had uterine leiomyosarcoma, three patients had cervix leiomyosarcoma, and three patients had vaginal leiomyosarcoma. The mean size was 6.4 (range: 3–10) cm. The staging workup didn’t show any metastatic lesion for all the patients. Fifteen patients underwent surgery as initial treatment, while one patient underwent external beam radiotherapy followed by brachytherapy. Adjuvant chemotherapy was done in four patients, and adjuvant radiotherapy was done in 7 patients. Six patients were diagnosed with LMS grade 1, three patients had grade 2, and 7 patients had grade 3. Median of follow up was 61 months. Nine patients had a complete remission; five patients had a progressive disease course, while two patients had a locoregional recurrence. Seven patients died of disease.

Conclusions The relative rarity of LMS, as well as their pathological diversity, hinders studies aimed at improving understanding of the disease and makes it difficult to define the optimum management.