Ovarian cancer is the deadliest gynecological malignancy in Western countries. Early detection, however, is hampered by the fact that the origin of ovarian cancer remains unclear. Knowing that in a high percentage of endometrioid ovarian cancers Wnt/b-catenin signaling is activated, and in view of the hypothesis that ovarian cancer may originate from the distal oviduct, we studied mice in which Wnt/b-catenin signaling was activated in M€ ullerian duct-derived tissues. Conditional adenomatous polyposis coli (Apc) knockout mice were used to study the activation of Wnt/b-catenin signaling in M€ ullerian duct-derived organs. These Pgr Cre/1 ;Apc ex15lox/lox mice (n 5 44) were sacrificed at 10, 20, 40 and 80 weeks and uterus, oviduct, ovaries and surrounding fat tissues were assessed using immunohistochemistry. Using nuclear b-catenin staining, Wnt/b-catenin signaling activation was confirmed in the entire epithelium of the adult M€ ullerian duct (fimbriae, oviduct and endometrium), but was absent in ovarian surface epithelium cells (OSEs). Besides endometrial hyperplasia, in 87.2% of mice intraepithelial lesions of the distal oviduct were found, whereas OSEs remained unaffected. In addition, 62.5% of mice developed tumors in the distal and fimbrial part of the oviduct. In the ovaries, mainly at young age, in 16.3% of mice, simple epithelial cysts were noted, which developed further into endometrioid ovarian tumors, resembling human endometrioid ovarian cancer (27.9% of mice). Next to this, locoregional growth in the utero-ovarian ligament was also shown. Here, for the first time, mutations (activation of Wnt/b-catenin) in the distal oviduct result in precursor lesions that develop into ovarian tumors, resembling human endometrioid ovarian cancer.Epithelial ovarian cancer is the deadliest gynecological malignancy in Western countries, accounting for more than 140,000 deaths each year worldwide. 1 As ovarian cancer survival is highly dependent on the tumor stage at diagnosis, early detection is key to decreasing death rate. Unfortunately, the origin of ovarian cancer remains unclear, making early discovery very difficult.For decades, ovarian surface epithelial cells (OSEs) have been appointed as the primary origin of epithelial ovarian cancer despite the fact that precursor lesions were never found.2 Over recent years, however, researchers have proposed different origins for epithelial ovarian cancer: the secondary M€ ullerian system, 3 the distal oviduct and fimbriae 4,5 and recently the transitional zone between OSEs and mesothelium at the hilial region of the ovary.6 Dubeau 3 and Piek et al. 7 were among the first to question OSEs as the only origin of ovarian cancer. In his original article, Dubeau 3 argues that the strong resemblance of ovarian epithelial tumors to tumors arising from organs embryologically derived from the M€ ullerian ducts and warrants the consideration that components of the secondary M€ ullerian system play a role in ovarian tumorigenesis. Piek et al. described dysplastic lesions in prophylac...