Atypical Staggered Spread of Mutant p53-Driven High-grade Serous Ovarian Carcinoma: A Case Report of a Postmenopausal Woman

Introduction: High-grade serous ovarian carcinoma (HGSOC) is the most prevalent and aggressive subtype of ovarian cancer, comprising approximately 90% of cases. It is often associated with poor prognosis due to its typically widespread dissemination at presentation. This report highlights an unusual case of HGSOC with p53 positivity on immunohistochemistry (IHC), demonstrating an atypical, localized pattern of spread. Case Report: A 63-year-old postmenopausal woman presented with chronic abdominal pain. Clinical examination revealed a fair general condition and a centrally located, solid abdominal mass, resembling a 16-week gravid uterus. Per vaginal examination confirmed a uniformly enlarged uterus with an associated mass and free bilateral fornices. The patient reported intermittent symptoms over the past two years and had previously been diagnosed with an ovarian mass, for which she had relied on herbal remedies. MRI identified a large, irregular, lobulated pelvic mass (10 × 8.7 × 11.4 cm) infiltrating the left myometrial wall, accompanied by an elevated CA125 level. Staging laparotomy confirmed HGSOC with histopathological validation. Tumor deposits were observed in the omentum and bladder peritoneum, while the parietal peritoneum, diaphragm undersurface, and liver remained uninvolved. Notably, no gross ascites was observed. IHC analysis showed tumor cells positive for WT1, CK7, and mutant p53, confirming the diagnosis of HGSOC. Interestingly, despite diffuse p53 positivity and the aggressive nature of HGSOC, the patient exhibited an unusually staggered disease progression, characterized by localized metastases and the absence of ascites. Conclusion: This case of HGSOC exhibited an atypical, localized spread within the abdominal region despite its aggressive nature and p53 mutation, highlighting the heterogeneous clinical behavior of HGSOC. Recognizing such unconventional patterns is crucial for accurate diagnosis, management, and prognosis. The staggered metastatic pattern, despite diffuse p53 positivity, challenges conventional views on HGSOC progression. This underscores the need for advanced molecular profiling, including targeted genomic sequencing, to identify novel mutations that may influence tumor behavior and therapeutic response, ultimately guiding personalized treatment strategies and refined prognostic models.