A 55-year-old postmenopausal woman has a known fibroid that has shown rapid enlargement over 6 months along with new onset pelvic pain. Ultrasound shows irregular margins, central necrosis, and Doppler reveals circumferential vascularity. The MOST appropriate next step is:

• A Total hysterectomy with histopathological examination ✓
• B Uterine artery embolisation
• C Reassurance and annual ultrasound follow-up
• D GnRH agonist therapy for 3 months

Explanation

Rapid growth of a fibroid after menopause, especially with pain, irregular margins and necrosis, is the classic picture of leiomyosarcoma. Postmenopausal growth without hormone exposure is a red flag because benign fibroids normally shrink once oestrogen levels fall. GnRH agonists and UAE are inappropriate as they delay diagnosis, and observation risks missing malignancy. Hysterectomy with intact specimen allows accurate histological staging.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.