Hysteroscopy in a woman with heavy menstrual bleeding shows a submucosal fibroid attached to the uterine wall by a narrow stalk, projecting entirely into the cavity with no intramural extension. How is this fibroid classified in the FIGO system, and what is its preferred treatment?

• A FIGO Type 1, abdominal myomectomy
• B FIGO Type 0, hysteroscopic myomectomy ✓
• C FIGO Type 2, laparoscopic myomectomy
• D FIGO Type 5, uterine artery embolization

Explanation

The FIGO classification grades submucosal fibroids by intramural extension: Type 0 is pedunculated and wholly intracavitary, Type 1 has less than 50 percent intramural extension, and Type 2 has 50 percent or more. B completely pedunculated Type 0 fibroid is ideally removed by hysteroscopic resection, which avoids any incision into the myometrium. Types 1 and 2 require progressively more skill and carry higher risk of incomplete removal.

Reference: Williams Gynecology, 4th ed.

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