A 52-year-old postmenopausal woman with a known 6 cm uterine fibroid reports that it has increased to 9 cm over the past 6 months. There is no abnormal bleeding. What is the most appropriate next step?

• A Observation with repeat ultrasound in 6 months
• B MRI pelvis with contrast to assess for sarcomatous change ✓
• C Total abdominal hysterectomy with bilateral salpingo-oophorectomy
• D Endometrial biopsy alone

Explanation

Rapid growth of a uterine fibroid in a postmenopausal woman raises concern for leiomyosarcoma, although the overall risk of sarcomatous change in fibroids is low (0.1 to 0.5 percent). MRI with contrast can help differentiate benign from malignant features. Observation is inappropriate given the rapid growth in a postmenopausal patient. Hysterectomy may be indicated but should be guided by imaging findings.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.