Carcinoma Endometrium MCQs

Explanation: In an infant with severe microcytic hypochromic anemia requiring transfusions, the most likely diagnosis is beta-thalassemia major . Hemoglobin electrophoresis is the definitive test, which would show a significant increase in Hemoglobin F (HbF) and possibly Hemoglobin A2 (HbA2) , with absent or reduced Hemoglobin A (HbA). Explanation of other options: Serum iron (Option A): Would be normal or elevated in thalassemia (due to transfusions), but low in iron deficiency. It is not the definitive test. Direct coomb's test (Option B): Used to diagnose autoimmune hemolytic anemia. Osmotic fragility test (Option C): Used to diagnose hereditary spherocytosis, which causes a normocytic or macrocytic anemia, not microcytic. Key Takeaways: Thalassemia major presents in infancy with severe transfusion-dependent microcytic anemia. Hemoglobin electrophoresis is the key diagnostic test.

Metropathia hemorrhagica is the same as cystic glandular hyperplasia and is a causative factor for endometrial cancer. Gynandroblastoma is a virilising tumor which secretes androgens (not estrogens) and so does not lead to endometrial cancer Dysgerminoma is a neutral tumor which doesnot secrete either male or female sex hormones but secretes placental alkaline phosphatase, LDH and BHCG and therefore doesnot lead to endometrial cancer. Reference : Shaw 14 th /ed pg 3386 Reference : Dutta Gynae 5 th /ed pg 184

Ovarian pain is referred along the medial side of thigh The obturator nerve during its course, when runs in front of the internal iliac vessels is separated from the normally situated ovary by only the parietal peritoneum lining the pelvic wall, thus pain from the ovary may be referred along the nerve to the skin on the medial side of thigh. Also know Simpson Pain - colicky pain in patients of Ca Endometrium. It is referred to the hypogastrium or to both iliac fossae. It is not severe and tends to appear at the same time each day lasting only 1–2 hours. Reference : Lasts Anatomy 10th/ed pg 302

Long-term tamoxifen therapy is a predisposing factor for endometrial hyperplasia and cancers. Malignancies caused by long-term tamoxifen therapy: Carcinoma endometrium-it is the most common carcinoma associated with it. Uterine sarcoma. Rarely liver cancer with long-term high dose. Non malignant effects of tamoxifen on uterus: Endometrial hyperplasia Endometriosis Fibroid uterus Ovarian cysts Menstrual irregularities or amenorrhea. Reference : Shaw 15 th /ed pg 417, Reference : Novak 14 th /ed pg 1345

Before answering these questions I want all of you to quickly revise staging of Ca Endometrium. Vaginal metastasis means stage IIIB Lymph node involvement is seen from stage IIIC onwards. Bowel involvement /rectal involvement means stage IVA. Lung metastasis means stage IVB. Serosa involvement/positive peritoneal cytology means stage IIIA. The question is about stage IIIB, so everything involved before it is also included. Reference : Novak 15 th /ed pg 1265; Reference : Shaw 15 th /ed pg 420.

Indications of adjuvant radiotherapy: Extrauterine extension. Lower uterine or cervical involvement. Papillary serous or clear cell histology. Poor histologic differentiation (Grade III). Myometrial penetration greater than 1/2 of thickening. Pelvic node involvement. Reference : Shaw 15 th /ed pg 420; Reference : Novak 15 th /ed pg 1275.

Premalignant Lesions of Endometrium are: Simple hyperplasia: Endometrium is thick. The glands are dilated and have outpouching and invaginations. They are crowded and have irregular outlines. The stroma is more dense and cellular. Complex hyperplasia: Endometrium is thicker. The glands are crowded and arranged back to back with reduced stroma. Most glands have irregular outlines. There are papillary processes and intraluminal bridges within the glands. Epithelial pseudostratification is present. Atypical hyperplasia: The endometrial glands have cytologic atypia. The gland outlines are of complex hyperplasia in type. The nuclei of the glands show enlargement, irregular size and shape, hyperchromasia and coarse chromatin. Carcinoma-in-situ: Commonly describes a lesion with severe cytologic as well as architectural abnormalities of the glands. Reference : Dutta Gynae 6 th /ed pg 330

Arrangement of muscle fibres in the uterus are arranged in 3 layers. Outer longitudinal Inner circular Intermediate: – Is the strongest and thickest layer arranged in criss-cross fashion. Through this layer blood vessels run. Apposition of two double curve muscle fibre gives the figure of 8 form. When the muscle contracts they occlude the blood vessels running through the fibres and hence called Living Ligature. Reference : Dutta Obs. 7/e, pg 46