The dualistic pathways in the development of high-grade and low-grade serous carcinoma. Schematic illustration of type I and type II ovarian serous carcinoma.

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The dualistic pathways in the development of high-grade and low-grade serous carcinoma. Schematic illustration of type I and type II ovarian serous carcinoma pathogenesis. Development of ovarian high-grade (HGSC) and low-grade serous carcinomas (LGSC) involves 2 distinct pathways. LGSCs arise from serous low malignant potential tumors, which in turn develop from serous cystadenomas. This stepwise tumor progression in the low-grade pathway contrasts with the rapid progression pathway of high-grade (type II) carcinomas, for which precursor lesions are not well recognized. APST, atypical proliferative serous tumor; CIN, chromosomal instability; LOH, loss of heterozygosity; MPSC, micropapillary serous carcinoma. (Images contributed by Sonam Loghavi, MD and Denise Barbuto, MD, PhD.) Source: Epithelial Ovarian Cancers: Low Malignant Potential and Non-Serous Ovarian Histologies, Gynecologic Oncology: Clinical Practice and Surgical Atlas Citation: Karlan BY, Bristow RE, Li AJ. Gynecologic Oncology: Clinical Practice and Surgical Atlas; 2015 Available at: http://hemonc.mhmedical.com/DownloadImage.aspx?image=/data/Books/1381/kar_ch13_f003.png&sec=75544236&BookID=1381&ChapterSecID=75544225&imagename= Accessed: October 11, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved