Abstract

Background: High-grade serous ovarian carcinoma (HGSOC) is frequently associated with homologous recombination repair (HRR) deficiency due to BRCA1/2 mutations. Recognition of characteristic histopathological patterns in BRCA-mutated and HRD-positive tumours has diagnostic and therapeutic relevance. Objective: To identify distinctive histomorphological features associated with BRCA mutated and/or HRD-positive HGSOC and correlate them with clinicopathological parameters. Methods: A retrospective observational study was conducted. Of the 333 histologically confirmed HGSOC cases (2018–2024), 48 underwent BRCA testing, and 9 had concurrent HRD analysis. Archival haematoxylin and eosin (H&E) slides were reviewed for SET morphology (solid, pseudo-endometrioid, transitional), necrosis, nuclear pleomorphism, mitotic index, and tumour infiltrating lymphocytes (TILs). Clinical and molecular data were retrieved, and statistical associations were analysed using Chi-square and Fisher’s exact tests. Results: Among 48 tested cases, BRCA1 mutations were identified in 25% and BRCA2 in 2.1%; 33.3% (16/48) were BRCA / HRD positive. BRCA/HRD-positive tumours showed significantly higher frequencies of necrosis, high mitotic activity, lymphovascular invasion, and SET pattern. The odds of BRCA/HRD positivity were approximately 13–17 times higher in tumours exhibiting SET morphology. TILs were more frequent but not statistically significant.

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