Question

In a woman complaining of abnormal uterine bleeding (AUB), the following image was seen on endoscopic (hysteroscopic) examination of the uterus. What will be the diagnosis?

• A. Leiomyoma
• B. Adenomyosis
• C. Ovarian neoplasm
• D. Carcinoma of uterus

Hint:

Smooth pale rounded nodule bulging into the cavity in a woman with AUB.

Answer 1

The Correct Option is A

Step 1: Hysteroscopy of a woman with AUB shows a smooth, rounded, pale, well-circumscribed mass bulging into the uterine cavity. This is the typical appearance of a submucosal leiomyoma (fibroid).
Step 2: Leiomyoma is the most common pelvic tumour in women. It is benign and arises from the smooth muscle of the myometrium, and submucosal ones project into the cavity where the hysteroscope can see them directly.
Step 3: Submucosal fibroids classically cause abnormal uterine bleeding, and may also produce pelvic pain/pressure and infertility or adverse pregnancy outcomes - exactly the presentation given.
Step 4: Distractors: adenomyosis is endometrial glands within the myometrium and is diagnosed by imaging/histology, not as a discrete intracavitary mass. An ovarian neoplasm is outside the uterus and not visible at hysteroscopy. Endometrial carcinoma appears as a friable, irregular, necrotic growth, not a smooth pale nodule. Hence the answer is leiomyoma.