A 62-year-old woman undergoes endometrial biopsy for postmenopausal bleeding, which shows grade 1 endometrioid adenocarcinoma confined to an endometrial polyp with no myometrial invasion on subsequent MRI. During hysterectomy, frozen section confirms the tumour is confined entirely within the polyp. What is the prognostic significance of this finding?
- A It carries an excellent prognosis with very low risk of lymph node metastasis ✓
- B It upstages the tumour to FIGO Stage II
- C It indicates need for adjuvant chemotherapy regardless of final histology
- D It is associated with occult ovarian metastasis in 30% of cases
Correct answer: A. It carries an excellent prognosis with very low risk of lymph node metastasis
Explanation
Endometrioid adenocarcinoma confined entirely to an endometrial polyp with no myometrial invasion carries an excellent prognosis, with lymph node metastasis rates of less than 1%. Sentinel lymph node biopsy may be omitted in such cases. It does not upstage to Stage II as cervical stromal invasion is absent. Adjuvant therapy is not indicated for polyp-confined disease. Occult ovarian metastasis is rare in polyp-confined endometrioid carcinoma.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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