Study the Expression of Dickkopf-related Protein 3 Immunoreactivity in Serous Epithelial Ovarian Tumors

Background: Dickkopf-related protein 3 (DKK3) is regarded as a tumor suppressor in cancer tissue. DKK3 gene effect has an important role in the prognosis of ovarian cancer with the possibility to discover new line treatment in ovarian cancer. Many cancers of the uterus, cervix, colon, rectum, and pancreas show an association between decreased DKK3 protein and poor outcomes in these cancers. Objective: The study aims to evaluate the immunoreactive scores of DKK3 in all serous epithelial ovarian tumors (serous cystadenoma, serous borderline tumor, and invasive serous adenocarcinoma). Materials and Methods: A cross-sectional research was evaluated by immunohistochemistry, and involved 47 cases of ovarian serous tumor. DKK3 immunoreactive scoring resulted from multiplying the positive cells (mean percentage) by the staining intensity of the ovarian tissue. Therefore, the DKK3 expression score involves a 0 (undetected), 1+ (weakly positive), 2+ (moderately positive), and 3+ (intensely positive). Results: Of 47 patients, 12 (25.5%) had benign serous cystadenoma, 14 had (29.8%) serous borderline tumor, and 21 (44.7) had invasive serous adenocarcinoma. DKK3 immunoreactive score was significantly high in different types of ovarian tumors. Tumor ovarian locations were highly significant, in which unilateral tumor ovarian locations were mostly presented in serous borderline tumors 92.9% (13 of 14), whereas bilateral locations of ovarian tumors were more in invasive serous adenocarcinoma 71.4% (15 of 21). There is a significant positive correlation between the immunoreactive DKK3 score and ovarian neoplasms in benign serous cystadenoma, as well as a positive correlation between immunoreactive DKK3 score and the location of ovarian neoplasms in both serous borderline tumor and invasive serous adenocarcinoma. Conclusion: Serous ovarian tumors have a significant decrease in DKK3 protein expression, especially in serous borderline tumors and invasive serous adenocarcinoma. The DKK3 protein expression is affected by age groups, site location of tumor, and not affected by tumor size.