A 75 year old female presents to the doctor with a chief complaint of vaginal spotting. She has been postmenopausal for 25 years and does not take hormones. An ultrasound is performed, and shows a mass in the uterine fundus. A hysterectomy is performed, and pathologic examination of the removed uterus reveals a malignant tumor of the endometrial glands and stroma. Which of the following is the most likely diagnosis?

**Core Concept**
The patient presents with vaginal spotting and a uterine mass, and histopathological examination reveals a malignant tumor of the endometrial glands and stroma, indicating endometrial cancer. This condition is a type of gynecologic malignancy that arises from the endometrium, the lining of the uterus.

**Why the Correct Answer is Right**
Endometrial cancer is a common type of cancer in postmenopausal women, especially those who are obese or have a history of unopposed estrogen exposure. The tumor type most commonly associated with endometrial cancer is endometrioid adenocarcinoma, which arises from the endometrial glands. The presence of a uterine mass and vaginal spotting in a postmenopausal woman with a long history of unopposed estrogen exposure makes this diagnosis highly likely.

**Why Each Wrong Option is Incorrect**
**Option A:** Clear cell carcinoma is a rare type of endometrial cancer that is more aggressive than endometrioid adenocarcinoma, but it is not the most common type.
**Option B:** Serous carcinoma is another type of endometrial cancer, but it is more often associated with a worse prognosis and is less common than endometrioid adenocarcinoma.
**Option C:** Malignant mixed mullerian tumor is a rare tumor that contains both epithelial and mesenchymal components, but it is not the most likely diagnosis in this case.

**Clinical Pearl / High-Yield Fact**
Endometrial cancer is often associated with unopposed estrogen exposure, which can be due to obesity, polycystic ovary syndrome, or other conditions that lead to increased estrogen levels. A high index of suspicion for endometrial cancer should be maintained in postmenopausal women with vaginal bleeding or spotting.

**Correct Answer:** . Endometrioid adenocarcinoma

✓ Correct Answer: D. Malignant mixed mullerian tumor