Fimbrial Examination finds Mutant p53 Expression in Malignant Ovarian and Fallopian Tube Tumors, Suggests Study

Although high-grade serous ovarian carcinoma (HGSOC) is widely recognized to originate from precursor lesions like serous tubal intraepithelial carcinoma (STIC) in the distal fallopian tube rather than the ovarian surface, significant diagnostic gaps persist regarding how p53 expression profiles correlate across paired tissue sites. To address this clinical uncertainty, Dr. M. Saranya and colleagues from the Department of Pathology at ESIC Medical College and Hospital in Chennai conducted an investigation aimed at characterizing and comparing p53 expression patterns in ovarian neoplasms and corresponding fallopian tubes.

Therefore, in the 5-year retrospective study at a South Indian tertiary care institute, researchers evaluated 62 malignant epithelial ovarian cases—excluding non-epithelial tumors and inadequate tissue samples—to compare ovarian and fallopian tube p53 expression using standard transverse sections or the Sectioning and Extensively Examining the FIMbriated end (SEE-FIM) protocol. Statistical agreement between the two tissue sites was subsequently analyzed using Cohen’s kappa test in SPSS.

Key Clinical Findings of the Study Includes:

• High Ovarian Aberrance: Investigators noted aberrant mutant p53 expression in 52% of ovarian malignancies, with diffuse nuclear overexpression (≥80%) comprising 39% and null or cytoplasmic patterns accounting for 13%.
• Histotype Subtype Divergence: Researchers observed pronounced discordance in HGSOC, where ovaries exhibited 68% mutant p53 versus 32% in paired tubes, while low-grade serous carcinoma displayed 100% wild-type ovarian staining alongside 100% mutant tubal expression.
• Enhanced Precursor Yield: Authors detected STIC or p53 signatures in 40% of cases subjected to the specialized SEE-FIM protocol, with all precursor lesions demonstrating complete concordance for mutant p53.
• Poor Statistical Concordance: Analysts documented minimal inter-site agreement between ovarian and fallopian tube p53 expression (Cohen’s kappa = −0.025; McNemar’s p = 0.840), reinforcing a complex clonal and migratory tubal origin model.

The results suggest that systematic histological evaluation of the fimbria using the SEE-FIM protocol paired with standardized p53 interpretation substantially improves precursor detection, revealing mutant p53 in 52% of ovarian tumors and 38% of fallopian tubes. This molecular alignment across anatomical sites reinforces the fallopian tube as a critical site of origin in serous ovarian carcinogenesis.

Pathologists and surgical oncologists should consider implementing comprehensive fimbrial sectioning protocols alongside p53 immunohistochemistry during routine processing of ovarian resection specimens to enhance early precursor identification and refine patient risk stratification.

While limited by a single-institution retrospective sample size, these findings underscore the necessity for prospective multi-center studies with expanded patient cohorts to further validate inter-site molecular concordance and optimize early diagnostic pathways.

Reference

Saranya M, Priavadhana RP, Meenakshisundaram K. P53 expression patterns in the ovary and fallopian tube in patients with ovarian carcinoma: A 5-year, single-institution study. Indian J Pathol Oncol. 2026;13(3):212-218.