The distal half of chromosome arm 18q is frequently lost in ovarian carcinoma. To define the putative tumor suppressor locus/loci more precisely we performed allelic analysis with 27 polymorphic microsatellite markers located at 18q12.3-q23 in 64 serous and 9 mucinous ovarian carcinomas. Fifty-nine percent of the serous carcinomas, but only one (11%) of mucinous carcinomas, showed allelic loss at one or more loci (P ؍ 0.018). In serous carcinomas, deletions were found to be associated with tumor grade and poor survival. The highest frequency of losses was detected at the distal part, 18q22-q23. Two minimal common regions of loss (MCRL) were identified at this region: MCRL1 between D18S465 and D18S61 at 18q22 (3.9 cM) and MCRL2 between D18S462 and D18S70 at 18q23 (5.8 cM). At 18q21.1, proximal to the MCRLs, there are three candidate tumor suppressor genes: SMAD4 (DPC4), SMAD2, and DCC. Their protein expression was studied by immunohistochemistry in normal ovarian tissue and serous carcinomas. Lost or very weak expression of SMAD4, SMAD2 and DCC was found in 28, 28, and 30% of serous carcinomas, respectively. Comparison of allelic loss and protein expression status indicated that none of these genes alone could be the target for the frequent allelic loss at 18q21.1. Together, these genes may account for a substantial proportion of the events, but not all of them. Thus, we propose that the frequent allelic loss at 18q is because of the effect of multiple genes, and there is at least one as yet unidentified tumor suppressor gene at 18q residing distal to SMAD4, SMAD2, and DCC involved in serous ovarian carcinoma. (Am J Pathol 2001, 159:35-42) On the basis of comparative genomic hybridization analyses, the distal half of 18q is a site of frequent loss of genetic material in ovarian carcinoma. 1,2 Three candidate tumor suppressor genes have been identified at 18q21.1: SMAD4 (DPC4), SMAD2, and DCC, 3-5 but few mutations in these genes have been detected in ovarian carcinoma. 6 -8 Ovarian carcinoma originates from the surface epithelium of the ovary. DCC has been shown to be expressed in the surface epithelium, 9 but it is not known if SMAD4 and SMAD2 are expressed in these cells. Furthermore, it is unknown if the expression of DCC, SMAD4, and SMAD2 is lost during malignant transformation. Previously, allelic loss has been studied with several markers at 18q21 in ovarian carcinoma, but fine allelotyping has not been performed at more distal regions of 18q (18q22-q23), which is the site of most frequent loss as suggested by comparative genomic hybridization results. 1,2 Ovarian carcinoma shows several different histological types, including serous, mucinous, endometrioid, and clear cell carcinomas. There is an increasing amount of biological and molecular evidence that different histological types of ovarian carcinoma should be regarded as distinct entities. 10 -14 The most common form of ovarian carcinoma is the serous histological type, which accounts for ϳ55% of all cases. In our previous comparative genomic hybri...