In a 57-year-old patient with postmenopausal bleeding and a 2.5 cm subserosal fibroid, what is the most likely diagnosis and the appropriate next step?

In a 57-year-old patient with postmenopausal bleeding and a 2.5 cm subserosal fibroid, what is the most likely diagnosis and the appropriate next step?

• A. Endometrial carcinoma; endometrial sampling
• B. Endometrial polyp; hysteroscopy
• C. Ovarian cancer; CA-125
• D. Cervical cancer; Pap smear

Answer: (D)

Postmenopausal bleeding always raises concern for endometrial pathology. In a 57-year-old, endometrial carcinoma is the most likely cause of bleeding, even if a subserosal fibroid is present elsewhere in the uterus. The appropriate next step is to obtain endometrial tissue for histology, typically via an endometrial biopsy or dilation and curettage, to confirm cancer or rule it out. A Pap smear screens for cervical changes but does not evaluate the endometrium and is not the best initial test for PMB. While a cervical cancer cause is possible, it is not the most likely explanation in this context, and the key to management is directly assessing the endometrium.

Postmenopausal bleeding always raises concern for endometrial pathology. In a 57-year-old, endometrial carcinoma is the most likely cause of bleeding, even if a subserosal fibroid is present elsewhere in the uterus. The appropriate next step is to obtain endometrial tissue for histology, typically via an endometrial biopsy or dilation and curettage, to confirm cancer or rule it out. A Pap smear screens for cervical changes but does not evaluate the endometrium and is not the best initial test for PMB. While a cervical cancer cause is possible, it is not the most likely explanation in this context, and the key to management is directly assessing the endometrium.