A 48-year-old woman presents with abnormal uterine bleeding and a 2.5 cm submucosal fibroid on imaging. What is the diagnosis and most appropriate management?

• A. Fibroid; myomectomy
• B. Endometrial cancer; endometrial sampling
• C. Ovarian cyst; oophorectomy
• D. Cervical cancer; conization

Answer: (B)

Abnormal uterine bleeding in a perimenopausal patient requires evaluating the endometrium for cancer or hyperplasia, not assuming the bleeding is only due to a fibroid. In women around this age, the risk of endometrial pathology rises, so the next best step is to obtain tissue for histology to rule out malignancy. A submucosal fibroid can contribute to bleeding, but it does not exclude endometrial cancer, and imaging alone cannot differentiate benign from malignant endometrial processes. Therefore, endometrial sampling (endometrial biopsy) is the most appropriate immediate management because it provides a definitive diagnosis and guides further treatment. If pathology shows cancer, management would then proceed with definitive oncologic treatment; if benign, care would shift to addressing the fibroid-related symptoms.