Unraveling P53 Expression In Surface Epithelial Ovarian Tumors: A Clinicopathological Insight From A Tertiary Care Center

Abstract

Introduction: Ovarian cancer remains a major health concern, ranking as the fifth leading cause of cancer-related deaths in women. Among its various histological types, surface epithelial ovarian tumors (SEOTs) account for approximately 90% of all ovarian malignancies. These tumors demonstrate diverse biological behaviours ranging from benign to borderline and malignant. The tumor suppressor gene p53, known for its role in cell cycle regulation and apoptosis, has been widely studied as a potential biomarker in ovarian cancer. Altered p53 expression is often associated with high-grade tumors, poor prognosis, and resistance to chemotherapy.

Objectives: This study aims to assess the immunohistochemical expression of p53 in various subtypes and grades of surface epithelial ovarian tumors and correlate its staining patterns with their histopathological classification.

Materials And Methods: A retrospective study was conducted over two years (January 2023 to December 2024) and included 30 histologically confirmed cases of surface epithelial ovarian tumors. These cases were categorized as benign, borderline, or malignant based on standard histopathological criteria. Immunohistochemistry (IHC) for p53 was performed on all cases, and expression was evaluated based on nuclear staining patterns, categorized as wild-type, overexpression, or null.

Results: Total of the 30 cases studied, 18 (60%) were benign, 5 (16.7%) borderline, and 7 (23.3%) malignant. Benign tumors showed wild-type p53 expression, indicating normal p53 function. Borderline tumors demonstrated partial or focal nuclear positivity, reflecting a potential transition toward malignancy. In contrast, malignant tumors displayed aberrant p53 expression, including both diffuse nuclear overexpression and complete absence (null pattern). Notably, all p53-positive malignant tumors were of serous subtype. Mucinous carcinomas did not exhibit p53 positivity. The most common clinical presentation was abdominal pain, with contributory risk factors including family history, late menopause, and tumor laterality.

Conclusion: This study highlights the diagnostic and prognostic significance of p53 expression in surface epithelial ovarian tumors. The progressive pattern—from wild-type in benign, to partial positivity in borderline, to aberrant expression in malignant tumors—emphasizes the importance of p53 as a molecular marker. Accurate interpretation of IHC staining is crucial for diagnosis, grading, and potential application in targeted therapies, especially in high-grade serous carcinomas