It is now recognized that the fimbrial end of the fallopian tube is the source of many (and some believe all) “ovarian” pelvic high-grade serous carcinomas. The spectrum of serous tubal neoplasia includes p53 signatures, serous lesions of uncertain significance, serous tubal intraepithelial carcinoma, and high-grade serous carcinoma. These entities have unique morphologic, immunophenotypic, and genetic features, with varying clinical significance. Additionally, while other malignancies of the fallopian tube are uncommon, the fallopian tube is a frequent site of metastatic disease from not only the ovary and uterus but also distant sites (most often the gastrointestinal tract and breast). Metastases may involve the serosa, mucosa, muscular wall, or intravascular spaces. Because the fimbriae are a site of serous carcinogenesis, the SEE-FIM grossing protocol was developed to extensively sample the fimbria in risk-reducing salpingectomies and is now applied in many specimens containing salpingectomies, including those from low-risk women. At a minimum, entirely submitting and examining the distal fallopian tube is generally advised.