A 50-year-old woman with Stage IA grade 1 endometrioid adenocarcinoma undergoes total hysterectomy and bilateral salpingo-oophorectomy. Final histopathology reveals extensive lymphovascular space invasion (LVSI). What is the clinical significance of extensive LVSI in this otherwise low-risk tumour?

• A It has no prognostic significance in Stage IA grade 1 tumours
• B It increases the risk of pelvic lymph nodal metastasis and may warrant adjuvant therapy ✓
• C It indicates the tumour is actually a serous carcinoma on immunohistochemistry
• D It mandates completion para-aortic lymphadenectomy

Explanation

Extensive LVSI is an independent adverse prognostic factor in endometrial carcinoma, associated with increased risk of lymph nodal metastasis, distant recurrence, and cancer-specific mortality even in otherwise low-risk Stage IA grade 1 endometrioid tumours. It may upstage consideration for adjuvant therapy, particularly vaginal brachytherapy or pelvic radiotherapy. It does not change histological type. Completion lymphadenectomy is not routinely mandated solely for LVSI without other high-risk features.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.