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Rukmini Bezbaruah: Interpreting p53 Across Gynaecological Cancers
Rukmini Bezbaruah/LinkedIn
Mar 26, 2026, 07:32

Rukmini Bezbaruah: Interpreting p53 Across Gynaecological Cancers

Rukmini Bezbaruah, Associate Professor Oncopathology at Dr. B. Borooah Cancer Institute, shared a post on LinkedIn:

“Interpreting p53 Across Gynaecological Cancers: One Marker, Multiple Meanings

In gynaecological pathology, TP53 is one of the most frequently altered genes. Yet, its immunohistochemical interpretation is often reduced to a simplistic label – ‘positive’ or ‘negative.’

That approach is no longer acceptable.

p53 must be interpreted as a pattern, and more importantly, in the context of tumour type.

Core principle: Pattern-based interpretation

  • Wild-type (p53wt) → patchy, variable nuclear staining
  • Abnormal (p53abn) →
    • Diffuse strong nuclear (overexpression)
    • Complete absence (null)
    • Cytoplasmic (rare)
    • Subclonal (emerging category)

Tumour-specific interpretation matters

1. High-grade serous carcinoma (ovary/fallopian tube)

  • Nearly universal p53 abnormality
  • p53abn = diagnostic support
  • p53wt → reconsider diagnosis

2. Endometrial carcinoma

  • Majority are p53 wild-type
  • p53abn defines a distinct molecular subgroup with poor prognosis
  • Now integrated into molecular classification algorithms

3. Low-grade serous carcinoma

  • Typically p53 wild-type
  • p53abn → red flag for misclassification

4. Clear cell carcinoma

  • Heterogeneous p53 expression
  • Interpretation requires strong morphologic correlation

5. Cervical carcinoma

  • p53 IHC is less reliable as a surrogate marker
  • In HPV-associated tumors, p53 is often degraded → variable staining

What do recent guidelines emphasize?

  • p53 is a surrogate for mutation, not a simple marker
  • Interpretation must be:
    • Pattern-based
    • Context-specific
    • Integrated with morphology and molecular data
  • In endometrial carcinoma, p53 status is now part of:
    • ESGO–ESTRO–ESP classification
    • FIGO 2023 staging refinement

Common pitfalls

  • Reporting ‘p53 positive’
  • Missing null pattern due to lack of internal control
  • Overcalling wild-type as abnormal
  • Ignoring tumour context

Take-home message

p53 does not behave the same across all gynaecological cancers.

Its value lies not just in detection – but in interpretation within the right biological and morphological framework.”

Rukmini Bezbaruah

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Cervical carcinoma Cytoplasmic Endometrial carcinoma Fallopian tube Fertility Fertility News Gynaecological Cancers High-grade serous carcinoma In HPV-associated tumors Low-grade serous carcinoma ovary p53 Rukmini Bezbaruah Tumour-specific interpretation
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