The cases presented in this report highlight the diagnostic complexity of FH-deficient uterine leiomyomas and the health disparities and potential deficiency of complete care in Appalachia. In all three cases, histopathological findings pointing to FH-deficient uterine leiomyoma indicated the pursuit of an immunohistochemical stain. The gene discussed is FH; the disease is Uterine leiomyoma.