A 38-year-old woman with a 7 cm intramural fibroid and 4 cm submucosal fibroid (FIGO classification type 2) presents with heavy menstrual bleeding and subfertility. Her AMH is 2.1 ng/mL. According to FIGO leiomyoma classification, the submucosal fibroid is type 2 because:
- A It is entirely within the uterine cavity with no intramural extension
- B It has 50% or more intramural extension, bulging into but not primarily within the cavity ✓
- C It has less than 50% intramural extension, lying mainly in the submucosa
- D It lies entirely within the myometrium abutting the endometrial cavity without distortion
Explanation
The FIGO 2011 leiomyoma classification (PALM-COEIN) defines submucosal fibroids by their relationship to the endometrial cavity: Type 0 = pedunculated, entirely intracavitary; Type 1 = >50% intracavitary (intracavitary component exceeds intramural); Type 2 = ≤50% intracavitary (≥50% intramural extension, i.e., the fibroid extends predominantly into the myometrium but distorts the cavity). Type 2 fibroids are the most challenging submucosal type for hysteroscopic resection due to deep intramural extension, often requiring a two-stage procedure. This distinguishes them from Type 1 (easier single-stage hysteroscopic resection).
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.