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The discovery of a serous carcinogenic sequence in the distal fallopian tube has shifted attention to the role of the fimbria in both early detection and prevention of high-grade serous carcinoma (HGSC). Ultimately, what has emerged is an appreciation of two different trajectories of HGSC development, one delayed, often following the discovery of significant precursors (STIC) by several years and another, characterized by the seemingly sudden emergence of widespread disease. This presentation will address the possible explanations for these two trajectories from the pathologic and molecular perspective and, in the context of emerging follow-up data, outline two different opportunities for preventing and lowering the mortality rate for this most lethal form of "ovarian" cancer. At the conclusion of this presentation, attendees should be able to: 1 Describe two evolutionary pathways for serous tubal intraepithelial carcinoma (STIC) 2. Describe two possible molecular events leading to rapidly developing high-grade serous carcinoma 3. Describe two potential opportunities for preventing high-grade serous carcinoma Christopher P. Crum, MD Professor of Pathology, Harvard Medical School Division of Women’s and Perinatal Pathology Department of Pathology Brigham and Women’s Hospital 03/07/23