A 67-year-old woman undergoes hysterectomy for postmenopausal bleeding. The uterus is normal sized and atrophic. Histology reveals uterine papillary serous carcinoma limited to an endometrial polyp with less than 5 percent myometrial invasion. Peritoneal washings are positive and omental seedlings are found. Which feature best explains this behaviour?
- A Estrogen receptor positivity driving peritoneal dissemination
- B p53 mutation conferring aggressive biology similar to high-grade serous ovarian carcinoma ✓
- C Mismatch repair deficiency causing rapid nodal metastasis
- D Coexistent endometrioid component dominating the metastases
Correct answer: B. p53 mutation conferring aggressive biology similar to high-grade serous ovarian carcinoma
Explanation
Uterine serous carcinoma is a type II carcinoma characterised by near-universal TP53 mutations and behaves like high-grade serous ovarian carcinoma: it spreads transcoelomically across peritoneal surfaces even when intrauterine disease is tiny or confined to a polyp with negligible myometrial invasion. It is typically estrogen receptor negative, which rules out option A, and mismatch repair deficiency defines the indolent endometrioid pathway, ruling out C.
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.