A 71-year-old woman presents with postmenopausal bleeding. Curettage shows a tumour with marked nuclear pleomorphism, prominent nucleoli, mitotic figures including atypical forms, slit-like glandular spaces and psammomatous calcification. Myometrial invasion is minimal. Which feature best explains her poor prognosis?
- A Psammoma body formation indicates transcoelomic spread
- B Uterine serous carcinoma spreads lymphatically even when confined to a polypoid lesion ✓
- C Minimal invasion excludes extrauterine disease
- D Her age precludes complete surgical staging
Correct answer: B. Uterine serous carcinoma spreads lymphatically even when confined to a polypoid lesion
Explanation
The histology describes uterine papillary serous carcinoma, a Type II tumour characterised by diffuse strong p53 accumulation and early lymphatic and intraperitoneal spread. Unlike endometrioid carcinoma, deep myometrial invasion is not required for dissemination; tumour limited to an endometrial polyp can still have occult peritoneal and nodal disease. This behaviour justifies full surgical staging with omentectomy regardless of apparent confinement, so option C is the tempting but wrong reassurance.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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