A 71-year-old woman presents with postmenopausal bleeding. She is lean and has no history of unopposed oestrogen exposure. Transvaginal ultrasound shows an atrophic uterus with endometrial thickness of 5 mm. Hysteroscopy-directed biopsy reveals a high-grade papillary tumour with marked nuclear pleomorphism. Which feature best explains her risk of peritoneal dissemination even with minimal myometrial invasion?
- A Haematogenous spread to bone
- B Transcoelomic spread through patent fallopian tubes ✓
- C Direct extension into the cervix
- D Continuous growth along the endometrial cavity
Correct answer: B. Transcoelomic spread through patent fallopian tubes
Explanation
This is uterine serous carcinoma. It characteristically arises in an atrophic endometrium of elderly women, may show only superficial myometrial invasion, yet sheds malignant cells through the fallopian tubes into the peritoneal cavity, producing omental and peritoneal implants exactly like advanced ovarian carcinoma. This transcoelomic route is why comprehensive surgical staging including omentectomy and peritoneal biopsies is mandatory. Haematogenous bone spread, cervical extension, and intracavitary growth do not explain the pattern of dissemination.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.