Endometrial carcinoma type II (serous carcinoma) differs from type I (endometrioid) in all of the following ways EXCEPT:

• A Type II arises in a background of endometrial hyperplasia with excess oestrogen ✓
• B Type II has TP53 mutations as the dominant molecular alteration
• C Type II is more aggressive and presents at higher FIGO stage
• D Type II occurs in postmenopausal women often with thin atrophic endometrium

Explanation

Type II endometrial carcinoma (serous subtype) arises from a background of atrophic, thin endometrium in older postmenopausal women via a TP53-mutant pathway, not from oestrogen-driven endometrial hyperplasia. Endometrial hyperplasia with atypia and PIK3CA/PTEN mutations is the precursor of type I (endometrioid) carcinoma, which is oestrogen dependent and has a better prognosis.

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

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