Which combination of findings in a woman with a presumed fibroid should raise the strongest suspicion of leiomyosarcoma?

• A Subfertility with a 5 cm intramural fibroid
• B Premenopausal age, multiple fibroids, and menorrhagia
• C Postmenopausal age, rapidly enlarging solitary uterus, and normal endometrial sampling ✓
• D Multiple fibroids with calcification on CT scan

Explanation

Leiomyosarcoma is suggested by a rapidly growing uterus in a postmenopausal woman, especially when growth continues despite GnRH agonist therapy, often as a solitary mass without coexisting fibroids. Calcification and multiplicity favour benign degenerated leiomyomas, since sarcomas are usually solitary. Premenopausal menorrhagia with multiple fibroids is the classic benign pattern, and calcification reflects long-standing hyaline change typical of leiomyoma.

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

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Written and medically reviewed by the StethoPrep medical team.