{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T09:18:30Z","timestamp":1787649510712,"version":"build-2736575974"},"reference-count":22,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T00:00:00Z","timestamp":1759104000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Surg Pathol"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>This case series highlights the diagnostic challenge of M\u00fcllerian carcinoma presenting as colonic metastasis. The morphology, immunohistochemical work-up, and the utility of p53 immunohistochemistry in delineating between high-grade serous carcinoma and low-grade serous carcinomas are reviewed. Four patients initially presented with metastatic tubo-ovarian carcinoma in a colon biopsy between 2012 and 2023. Specimens and immunohistochemical stains were processed following routine clinical workflows. Colon biopsies in all patients showed a malignancy exhibiting papillary morphology (+\/\u2212psammomatous calcifications and \u201cbottom-heavy\u201d architecture) or poorly differentiated morphology. All patients were evaluated for metastasis by immunohistochemistry to include keratins (KRT7 and KRT20 or AE1\/AE3), CDX2 or SATB2 (for gastrointestinal origin), and PAX8 (for M\u00fcllerian origin). Once M\u00fcllerian origin was established, further interrogation of the tumor with WT1, p53, and KI67 was essential to establish a diagnosis of high-grade serous carcinoma or low-grade serous carcinoma. Differing clinical management between high-grade serous carcinoma and low-grade serous carcinoma is summarized. Papillary morphology, \u201cbottom-heavy\u201d architecture, and psammomatous calcifications should prompt a metastatic work-up in colon biopsies. When a M\u00fcllerian site of origin is identified, a follow-up panel of markers\u2014to include p53\u2014should be used to distinguish between high-grade serous carcinoma and low-grade serous carcinoma to guide initial management options.<\/jats:p>","DOI":"10.1177\/10668969251378633","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T17:22:59Z","timestamp":1759166579000},"page":"501-507","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Serous Carcinomas Initially Diagnosed on Colon Biopsies: A Case Series Highlighting the Role of p53 to Guide Management"],"prefix":"10.1177","volume":"34","author":[{"given":"Brianna","family":"Waller","sequence":"first","affiliation":[{"name":"University of Vermont Larner College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Steinharter","sequence":"additional","affiliation":[{"name":"University of Vermont Larner College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5876-3981","authenticated-orcid":false,"given":"John M.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"University of Vermont Larner College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Ashley","sequence":"additional","affiliation":[{"name":"University of Vermont Larner College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer K.","family":"Abu Alfa","sequence":"additional","affiliation":[{"name":"University of Vermont Larner College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3166-4523","authenticated-orcid":false,"given":"Kristen E.","family":"Muller","sequence":"additional","affiliation":[{"name":"Dartmouth-Hitchcock Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4629-6375","authenticated-orcid":false,"given":"Bronwyn","family":"Bryant","sequence":"additional","affiliation":[{"name":"University of Vermont Larner College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,9,29]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21262"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21456"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0b013e3181c042b6"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26618"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PAP.0b013e3181b4fffa"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-46334-6"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0000000000000207"},{"key":"e_1_3_4_9_2","unstructured":"NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines\u00ae) for Ovarian Cancer including fallopian tube and primary peritoneal cancer version 1.2023. 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