Gynaecological pathology: endometrial carcinoma: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Gynaecological pathology: endometrial carcinoma

Sample item

A 58-year-old obese, diabetic nulliparous woman has postmenopausal bleeding. Biopsy shows crowded glands with endometrioid carcinoma. Which molecular alteration is most frequent in this tumour type?

APTEN loss of functionBGermline BRCA1 mutationCAPC mutationDTP53 mutation as the initiating event

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. PTEN loss of function

Type I endometrioid carcinoma is linked to prolonged unopposed oestrogen, shown by obesity, anovulation and nulliparity, and develops from atypical hyperplasia. Inactivating PTEN mutations are the most frequent alteration, along with PIK3CA, KRAS and microsatellite instability. Serous carcinoma, by contrast, arises in atrophic endometrium with TP53 mutation.

Option by option

A. PTEN loss of function (correct)
Correct. PTEN inactivation is the commonest alteration in endometrioid carcinoma.
B. Germline BRCA1 mutation
BRCA1 mutation is associated with ovarian high-grade serous and breast cancers.
C. APC mutation
APC mutation underlies familial adenomatous polyposis and colorectal adenomas.
D. TP53 mutation as the initiating event
TP53 mutation is the initiating event in serous carcinoma, not endometrioid carcinoma.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, PTEN loss of function. Type I endometrioid carcinoma is linked to prolonged unopposed oestrogen, shown by obesity, anovulation and nulliparity, and develops from atypical hyperplasia.

Why is "Germline BRCA1 mutation" not the answer?

BRCA1 mutation is associated with ovarian high-grade serous and breast cancers.

Why is "APC mutation" not the answer?

APC mutation underlies familial adenomatous polyposis and colorectal adenomas.

Why is "TP53 mutation as the initiating event" not the answer?

TP53 mutation is the initiating event in serous carcinoma, not endometrioid carcinoma.

What concept does this question test?

It tests Gynaecological pathology: endometrial carcinoma in Pathology. Inactivating PTEN mutations are the most frequent alteration, along with PIK3CA, KRAS and microsatellite instability. Serous carcinoma, by contrast, arises in atrophic endometrium with TP53 mutation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological pathology: endometrial carcinoma?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.