A 67-year-old woman undergoes hysterectomy for a uterine tumour confined to a polypoid mass with less than 5 percent myometrial invasion. Histology shows uterine serous carcinoma. At laparotomy, the surgeon notes small nodules on the omentum and peritoneal surfaces. This pattern of dissemination despite minimal myometrial invasion is best explained by which route of spread?

• A Transcoelomic exfoliation of malignant cells through the fallopian tubes ✓
• B Direct extension through the myometrium into the broad ligament
• C Haematogenous spread to the peritoneum
• D Retrograde lymphatic spread to inguinal nodes

Explanation

Uterine serous carcinoma behaves like epithelial ovarian cancer: malignant cells exfoliate from the uterine cavity, pass through the fallopian tubes, and implant on the peritoneal surfaces, producing omental and peritoneal disease independent of myometrial depth. This is why surgical staging requires peritoneal washing, omental biopsy and peritoneal biopsies. Haematogenous spread causes parenchymal metastases late, and lymphatic routes do not explain peritoneal seeding.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.