This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
Which of the following direct lymph node dissections in endometrial carcinoma : 
Select and explain. 
A. Penetration into half of myometrium, B. Clear cell Ca, C. Fundal involvement, D. All
D: All
Answer: D: All 
Explanation: Ans. is a, b and c i.e. Penetration into half of myometrium; Clear cell tumour; and Papillary serous carcinom Indications for lymph node (Pelvic and Para-aoic) dissection in Endometrial cancer (also Indications of poor Prognosis). 1. Tumour histology : Clear cell carcinoma Papillary serous carcinoma Squamous carcinoma Adenocarcinoma (Endometriod) grade II and Ill. More than half of myometrial Invasion Isthmus- cervix extension Tumour size > 2cms Extrauterine disease. As far as Peritoneal metastasis is concerned : "Positive Peritoneal cytology in itself is not a marker of poor prognosis i.e. is not an indication for lymph node dissection unless and until associated with other poor prognostic markers as above."