Endometrial carcinoma type II (serous carcinoma) differs from type I (endometrioid) in which important molecular feature?

• A Type II is associated with estrogen excess and Lynch syndrome (MSI-H)
• B Type II is well-differentiated with PTEN mutations and good prognosis
• C Type II is driven by KRAS and CTNNB1 mutations in a background of hyperplasia
• D Type II arises on a background of atrophic endometrium with TP53 mutations and aneuploid DNA, not related to estrogen ✓

Explanation

Type II endometrial carcinoma (serous/clear cell) arises from atrophic endometrium via p53 signature lesions (serous endometrial intraepithelial carcinoma), is associated with TP53 mutations, HER2 amplification, and aneuploidy. It is not estrogen-driven and has a poor prognosis. Type I (endometrioid) is associated with estrogen excess, PTEN/KRAS/CTNNB1 mutations, and has a better prognosis.

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

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