Pseudotumoral uterine lesions include benign reactive and artefactual changes, epithelial and mesenchymal, which occasionally are incorrectly interpreted as malignant or even premalignant lesions. Although some of these changes may have architectural or cytological abnormality, they are different from those observed in premalignant and malignant uterine lesions. The most common pseudotumoral lesions of the endometrium include various types of epithelial and stromal metaplasia, pseudolymphomas, inflammatory pseudotumor, adenomyosis, post-therapy surgical changes, artefactual changes, etc. Most of these changes may coexist with endometrial hyperplasia or endometrial carcinoma, and also with some benign conditions such as polyps or in combination with hormonal therapy or even in normal cyclic endometrium. These associated endometrial changes may raise important issues regarding the diagnosis and subsequent therapy.