Gynaecological oncology: leiomyosarcoma: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Gynaecological oncology: leiomyosarcoma

Sample item

A 58-year-old postmenopausal woman has a pelvic mass that has enlarged rapidly over 3 months with bleeding. MRI shows a heterogeneous mass with central necrosis and irregular margins. Which is the best approach?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Total hysterectomy with bilateral salpingo-oophorectomy without morcellation

Rapid growth of a presumed fibroid after menopause, with imaging showing necrosis, raises suspicion of leiomyosarcoma. Morcellation can disseminate tumour and worsens survival, so en bloc hysterectomy is done, and ovarian conservation is considered individually. Leiomyosarcoma responds poorly to chemotherapy and tends to spread to the lungs by the blood.

Option by option

  • A. GnRH analogue therapy

    Fibroids are expected to shrink after menopause, and hormone therapy is not appropriate here.

  • B. Uterine artery embolisation

    Embolisation would not give tissue diagnosis or definitive treatment.

  • C. Laparoscopic power morcellation of a fibroid

    Morcellation risks spreading malignant tissue.

  • D. Total hysterectomy with bilateral salpingo-oophorectomy without morcellation (correct)

    Correct. En bloc removal without morcellation is the safest approach for suspected sarcoma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Total hysterectomy with bilateral salpingo-oophorectomy without morcellation. Rapid growth of a presumed fibroid after menopause, with imaging showing necrosis, raises suspicion of leiomyosarcoma.

Why is "GnRH analogue therapy" not the answer?

Fibroids are expected to shrink after menopause, and hormone therapy is not appropriate here.

Why is "Uterine artery embolisation" not the answer?

Embolisation would not give tissue diagnosis or definitive treatment.

Why is "Laparoscopic power morcellation of a fibroid" not the answer?

Morcellation risks spreading malignant tissue.

What concept does this question test?

It tests Gynaecological oncology: leiomyosarcoma in OBG. Morcellation can disseminate tumour and worsens survival, so en bloc hysterectomy is done, and ovarian conservation is considered individually. Leiomyosarcoma responds poorly to chemotherapy and tends to spread to the lungs by the blood.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological oncology: leiomyosarcoma?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.