A 66-year-old postmenopausal woman undergoes hysterectomy for uterine serous carcinoma confined to an endometrial polyp, with no myometrial invasion on histology. Peritoneal washings return positive for malignant cells and omental biopsies show serous carcinoma deposits. Which behaviour explains this finding?

• A Haematogenous spread to the peritoneum via uterine veins
• B Direct transmyometrial invasion into the broad ligament
• C Contiguous spread to cervix and then to pouch of Douglas
• D Transtubal exfoliation and lymphovascular permeation occurring before any myometrial invasion ✓

Explanation

Uterine serous carcinoma behaves like ovarian carcinoma: malignant cells exfoliate through the fallopian tube and seed the peritoneum, and lymphovascular space invasion is frequent, so extrauterine disease may exist despite a uterus showing no or only superficial myometrial invasion. This is why comprehensive surgical staging including peritoneal biopsies and omentectomy is mandatory. Haematogenous spread occurs late and contiguous cervical spread does not produce diffuse peritoneal implants.

Reference: Williams Gynecology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.