Mass distorting the endometrium; least common site but most likely to cause symptoms

• A. Submucosal leiomyoma
• B. Intramural leiomyoma
• C. Subserosal leiomyoma
• D. Endometrial polyp

Answer: (A)

Submucosal leiomyoma is the lesion that best fits this scenario because it grows into the uterine cavity, directly distorting the endometrial lining. Although this location is less common than intramural or subserosal fibroids, the cavity distortion it causes explains the symptoms such as heavy uterine bleeding and potential fertility issues. In contrast, intramural fibroids sit within the myometrium and usually don’t distort the endometrium unless they’re very large, and subserosal fibroids project outward toward the serosa with minimal cavity involvement. An endometrial polyp lies within the endometrium itself and can cause bleeding, but the descriptor “mass distorting the endometrium” is classic for a submucosal fibroid protruding into the cavity.