Ovarian germ cell tumor

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overveiw

Ovarian germ cell tumors is a disease in which malignancy originates from the germ cells of the ovary. Ovarian germ cell tumors are rare, accounting for 2% to 3% of all ovarian cancers. The median age for diagnosis differs for each sub-type of germ cell tumor. World health organization (WHO) classified germ cell tumors into 7 types based on histology. The most common ovarian germ cell tumor is called dysgerminoma. Abnormal gonads (due to gonadal dysgenesis and androgen insensitivity syndrome) have a high risk of developing a dysgerminoma. Ovarian germ cell tumors must be differentiated from other neoplastic ovarian masses that can present with similar complaints non-neoplastic ovarian mass, and adnexal mass. Symptoms of ovarian germ cell tumors include abdominal distention, acute/ subacute abdominal pain, menstrual irregularities, and precocious puberty. The laboratory findings associated with ovarian germ cell tumors include rise in serum lactate dehydrogenase (LDH), human chorionic gonadotropin (HCG), CA-125, and alpha-fetoprotein (AFP). Depending on the extent of the tumor at the time of diagnosis, the prognosis may vary. CT, MRI, and ultrasound are used in combination with biopsy not only to distinguish between the subtypes of ovarian germ cell tumors but also for diagnosis confirmation. Surgery along with chemotherapy are the mainstay of treatment depending on the staging of the tumor.

Historical Perspective

There is limited information about the historical perspective of ovarian germ cell tumors.

Classification

Ovarian germ cell tumor may be benign or malignant. Each category sub classified to different types based on histologic features.

Pathophysiology

The pathophysiology of ovarian germ cell tumors depends on the histological subtype. Their common origin is believed to be from the primordial germ cells that transformed pathologically in different stages of development. It is difficult to distinguish subtypes of ovarian germ cell tumor on gross pathology alone. The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of hemorrhage and necrosis. On microscopic pathology, ovarian germ cell tumors may be characterized by a uniform “fried egg” appearance (dysgerminoma), presence of Schiller-Duval bodies (yolk sac tumor), presence of embryonic-like neural, gastrointestinal, and/or cartilaginous tissue (teratoma), or mixed histopathological features (embryonal cell carcinoma).

Epidemiology and Demographics

In USA, the age-adjusted incidence of malignant ovarian germ cell tumor is 0.41 per 100,000 women. Incidence of these tumors increases from 5 years of age, although it may be present during infancy, and this increase continues to peak between the age of 15 to 19 years which is approximately 1.2 per 100,000 women. Another peak incidence of these tumors has been reported among those aged 65 years old or older where teratoma is the most common type observed. The incidence is higher among non-white ethnicity (other than black, especially Hispanic and Asians) followed by white and black individuals. Females are more commonly affected by germ cell tumors than males. These tumors also account for a greater proportion of ovarian tumors in the Asia and Africa.

Risk Factors

Gonadal dysgenesis and androgen insensitivity syndrome are known risk factors for the development of ovarian germ cell tumors. There are also other maternal factors that have been observed to be associated with increased risk of the development of these tumors in daughters. Factors such as maternal use of exogenous hormones, maternal elevated body mass index, and reproductive factors.

Differentiating From Ovarian Germ Cell Tumor Other Diseases

Ovarian germ cell tumor must be differentiated from other diseases that cause ovarian mass, such as Stein-Leventhal syndrome, ovarian teratoma, tubal pregnancy, ovarian epithelial tumors, ovarian sex-cord stromal tumors, and tubo-ovarian abscess.

Prognosis

The prognosis of germ cells of the ovary depends on the type of the tumor and its malignant potentials. Possible complications of benign teratomas are a rupture and ovarian torsion also malignant transformation. Prognosis is generally excellent in the mature teratoma, but in case of simultaneous malignant transformation, the 5-year survival rate of patients is approximately [15-30]%. The 5-year survival rate of the patient even with disseminated dysgerminoma at the time of diagnosis is above 90%. The overall 5-year survival rate for yolk sac tumor, embryonal carcinoma and choriocarcinoma are approximately 80%.

Diagnosis

Staging

According to the FIGO and TNM cancer staging system, there are 4 stages of ovarian germ cell tumor. Surgery is the mainstay of staging for ovarian germ cell tumors.

History and Symptoms

The clinical manifestations of patients with ovarian germ cell tumors depend on the type of the tumor and its potential to produce hormonal materials. Usually, they present with abdominal pain or distention, menstrual irregularities, symptoms of virilization, rapidly growing abdominal/pelvic mass, acute abdominal pain from complications such as necrosis, capsular distention, rupture or torsion and or simply they can be asymptomatic.

Ovarian Germ Cell Tumor Physical Examination

Patients with germ cells of the ovary usually appear normal. Physical examination of these patients is usually unremarkable and the tumors tend to be discovered incidentally or during imaging workups for another reason. When symptomatic, the physical examination may be remarkable for Abdominal/pelvic mass and/or signs of virilization, precocious puberty, and pregnancy depending on the capacity of the tumor for the production of hormones.

Ovarian germ cell tumor Laboratory Findings

The laboratory findings associated with ovarian germ cell tumor are the following: elevated serum level of lactate dehydrogenase (LDH), human chorionic gonadotropin (HCG), CA-125, and alpha-fetoprotein (AFP).

CT

It is difficult to distinguish ovarian germ cell tumors on CT alone, however, pelvic/abdominal CT scan may be helpful in the diagnosis. Sensitive findings on CT scan for the diagnosis of mature teratoma include Fat attenuation, presence or absence of calcification in the cyst wall, palm-tree like protrusion, and fat–fluid levels. Presence of cauliflower appearance with irregular borders may warrant the necessity to search for malignant transformation of these tumors. CT scan findings characteristics of immature teratoma include A large, irregular solid mass, presence of coarse calcification, small foci of fat, and Hemorrhage. CT findings associated with other ovarian germ cell tumors are not specific, but may be helpful.

MRI

Abdominal/pelvic MRI may be helpful in the diagnosis of ovarian germ cell tumors. Findings on MRI suggestive of ovarian germ cell tumors include masses with a cystic and solid component and may contain fat, calcification, fat–fluid level, Tuft\Hairs, Palm tree-like protrusion, and Dermoid nipples-like elements (Rokitansky nodules). The majority of ovarian germ cell tumors have a solid and cystic appearance with areas of hemorrhage and necrosis. The predominance of cystic or solid component differs for each tumor.

Ultrasound

It is difficult to distinguish ovarian germ cell tumors on ultrasound alone. Both solid and cystic lesions with calcification may be present. Dysgerminoma often appears as a hypoechoic mass while other ovarian germ cell tumors often have variable echogenicity. Ovarian teratoma may be further characterized by the presence of sebaceous and hair components arising from the Rokitansky protuberance.

Treatment

Chemotherapy

Adjuvant Chemotherapy is recommended for all the patients with diagnosed malignant ovarian germ cell tumor, except those with stage 1a, stage 1a, 1b dysgerminoma, and grade 1 immature teratomas. The platinum-based regimen is currently the most effective management.

Radiotherapy

Among ovarian germ cell tumors, only dysgerminoma is radiosensitive. Radiotherapy is not anymore the first option of treatment for dysgerminoma considering its association with ovarian failure development.

Surgery

Surgical intervention is the mainstay of management of ovarian germ cell tumors. Surgery must be done for the purpose of staging and maybe treatment according to the stage of the tumor. Surgical management of the ovarian germ cell tumors, for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the ovary or not. Surgery is the mainstay of treatment for mature teratoma.

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Historical Perspective

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

There is limited information about the historical perspective of ovarian germ cell tumors.

Historical Perspective

Discovery

There is limited information about the historical perspective of ovarian germ cell tumors.

References

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Classification

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

Ovarian germ cell tumor may be benign or malignant. Each category sub classified to different types based on histologic features.

Classification

Ovarian germ cell tumor may be classified into two subtypes of benign and malignant tumors. Benign tumors are comprised of only teratoma, however, the malignant germ cell tumors may be classified to different types according to the histologic features.

Teratoma^[1]
- Mature cystic teratomas (dermoid cysts)
- Immature teratoma
- Monodermal teratoma
Dysgerminoma
Yolk sac tumor
Mixed germ cell tumors
Pure embryonal carcinoma
Non-gestational choriocarcinoma
Pure embryoma

WHO Classification of Ovarian Tumors

WHO classifies ovarian germ cell tumors as follows:^[2]

Teratoma
- Immature
- Mature
- Solid
- Cystic (dermoid cyst)
Dysgerminoma
Endometrial Sinus tumors
Embryonal carcinoma
Polyembryoma
Choriocarcinoma
Mixed germ cell tumors

References

↑ Outwater EK, Siegelman ES, Hunt JL (2001). “Ovarian teratomas: tumor types and imaging characteristics”. Radiographics. 21 (2): 475–90. doi:10.1148/radiographics.21.2.g01mr09475. PMID 11259710.
↑ Meinhold-Heerlein I, Fotopoulou C, Harter P, Kurzeder C, Mustea A, Wimberger P, Hauptmann S, Sehouli J (April 2016). “The new WHO classification of ovarian, fallopian tube, and primary peritoneal cancer and its clinical implications”. Arch. Gynecol. Obstet. 293 (4): 695–700. doi:10.1007/s00404-016-4035-8. PMID 26894303.

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Pathophysiology

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overveiw

The pathophysiology of ovarian germ cell tumors depends on the histological subtype. However, their origin is the primordial germ cells that transformed pathologically in different stages of development.

Pathophysiology

Pathogenesis

It is understood that ovarian germ cell tumors are the result of the pathologic transformation of primordial germ cells during different stages of the development.^[1]^[2]

Germ cell

Pathogenesis

Malignant transformation

Mature teratoma

Tumors esxpressing transcription factors of pluripotency

Tumors with primitive embryonic ectoderm, mesoderm, and/or endoderm differentiation

Tumors with extraembroyonic differentiation

Dysgerminoma/Embryonal carcinoma

Immature teratoma

Yolk sac tumor/Choriocarcinoma

Mature teratoma

Mature teratomas are benign tumors originating from pathologic development of primordial germ cells.^[3]
It originates from a single germ cell tumor after the first phase of meiosis.^[4]
These tumors contain the well-differentiated component of three germ layers.^[3]
Their usual location is the embryonic fusion line overhead and neck, mediastinum, a and presacral area and tend to present at a greater extent in the midline.

Dysgerminoma

Dysgerminoma arises from primordial germ cells, which are gonadal cells that are normally involved in the gametogenesis.^[1]
The majority of dysgerminomas in women present in the stage 1A.^[5]

Bilateral invovlement occurs in 10% to 15% of the cases.
In < 15% of the affected cases, elements of other germ cell tumors can also be found.^[6]

Yolk sac tumor

These tumors develop from differentiation of primitive germ cells in the direction of yolk sac or vitelline structures.^[7]
They tend to grow very rapidly.^[8]
Bilateral involvement occurs in less than 5% of the cases.
In 10% of the cases, the contralateral ovary carries a dermoid cyst.
In 40% of cases, they are accompanied by other types of germ cell tumors.^[9]

Genetics

Ovarian germ cell tumors may be associated with cytogenetic abnormalities.
Immature teratomas may be associated with chromosomal changes such as:^[10]
- Gain of all or parts of
  - 1p
  - 16p
  - 19
  - 22q
Dysgerminomas may be associated with gain or loss of complete or partial chromosomal materials such as:^[10]
- Gain of:
  - 1p
  - 6p
  - 12p
  - 12q
  - 15q
  - 20q
  - 21q
  - 22q
  - Whole of chromosome 7
  - Whole of chromosome 8
  - Whole of chromosome 17
  - Whole of chromosome 19
- Losses from 13q
Yolk sac tumor is associated with gaining of the 12p chromosome in 75% of the cases.^[10]
- It may also be associated with chromosomal changes such as:
  - Gain of 1q

Associated Conditions

Conditions associated with mature teratoma include:

Anti-NMDA receptor encephalitis (although very rarely)^[11]
Rarely, they contain pituitary cells capable of prolactin production and is associated with prolactinoma.^[12]

Polyembryoma may be associated with Klinefelter syndrome.^[13]

Gross Pathology

Ovarian germ cell tumor subtype	Features on Gross Pathology
Dysgerminonma	Unilateral (bilateral in 10% to 20% of the cases)^[14] more common on the right side Solid, white or grayish-withe tumors
Embryonal Carcinoma	Unilateral, large mass, averaging 17 cm ^[8] Smooth outer surface Extensive area of necrosis and hemorrhage
Endodermal sinus tumor or yolk sac tumors	Mixed solid and cystic component^[8] The solid portion is soft with grey to yellow color and areas of necrosis and/or hemorrhage The cystic portion is in between solid components and results in a meshlike/honeycomb appearance Unilateral and commonly affects the right ovary^[9]
Mixed germ cell tumors	Composed of more than one germ cell tumor element^[8] Main components are: Dysgerminoma Teratoma Yolk sac tumor Other germ cell tumors may be present
Polyembryoma	Large, unilateral tumor with microcystic surface^[15] Bulky appearance Soft and reddish-brown color hemorrhage in cut surfaces
Teratoma	Teratoma-mature The majority are 5 to 10 cm in diameter.^[16] Unilocular in the majority of cases (88%) Predominantly cystic Cystic content may contain sebaceous material that is semi-liquid in room temperature Teeth may be found in Rokitansky’s protuberance – a well-defined, nipple-like structure covered with hair Teratoma-immature Usually appear larger than mature teratomas^[17] May be solid or with a prominent solid element Cystic cavities may be filled with serous or mucinous or fatty-sebaceous fluid. The capsular component may not always be well-defined Teratoma-monodermal Struma ovarii: amber-colored thyroid tissue with areas of hemorrhage, necrosis, and fibrosis ^[17] Carcinoid tumor: a solid mass

Microscopic Pathology

Ovarian germ cell tumor subtype	Features on Histopathological Microscopic Analysis	Image
Dysgerminomas	large, uniform, clear cells arranged in sheets ^[8] Uniform cells has an “fried egg appearance“(large cytoplasm and small nucleus) that resemble primordial germ cells The stroma contains lymphocytes and septa like components.	Contributed by CoRus13 in wikimedia.commons
Embryonal carcinoma	Pseudoglandular pattern of primitive cells ^[8] Nuclei are: Large Croweded Pleomorphic With prominent nucleoli	Contributed by Nephron in wikimedia.commons
Endodermal sinus tumor or yolk sac tumors	Schiller-Duval bodies (resemble renal glomeruli) – key feature ^[8]	Micrograph showing the yolk sac component of a mixed germ cell tumor. Contributed by Nephrone in wikimedia.commons
Polyemryoma	Usually as a part of mixed germ cell tumor^[8] Contains small embryo-like bodies with central germ disks Germ disk cavity has two part: Embryonal carcinoma epithelia Two cavities: Dorsal cavity that resembles the amniotic cavity Ventral cavity that resembles the yolk sac cavity	Micrograph showing the embryoma component of a mixed germ cell tumor. Attributed by “courtesy of PathologyOutlines.com”
Teratoma	Mature teratoma The sections show ovarian parenchyma with a lesion consisting of benign dermal, gastrointestinal, and neural elements.^[18] The neural elements show focal degenerative changes with macrophages and giant cells Siderophages are present. In general, mature teratoma usually appears as a well-established organization of tissues mimicking the relationship observed in normal organs such as:^[19] respiratory epithelial layer surrounded by smooth muscle and cartilage Usually, there is scant mitosis in the tumor cells usually limited to the normal proliferative zone of the body part that they produce. No cytologic atypia is present. Different type of tissues may be observed in the mature teratomas of the ovary such as: Choroid plexus Thyroid tissues Pituitary tissues, although not commonly.^[12] Rarely, they produce prolactin and is associated with prolactinoma. Immature teratoma Tissues originating from the two or three embryonal layers are present.^[8] There is a mixture of mature and immature tissue (primitive cells). The presence of primitive elements is necessary to make the diagnosis.	Mature cystic teratoma of the ovary: Bone Tissue Pathological and histological images courtesy of Ed Uthman at flickr. Contributed by wikimedia commons

Immunohistochemistry

Dysgerminoma

Dysgerminoma is positive for:^[20]
- OCT4 (this marker is a key diagnostic factor for the diagnosis of dysgerminoma)

Embryonal carcinoma

These tumors are positive for:^[8]
- CD30
- EMA
- OCT3/4

Endodermal sinus tumor

Yolk sac tumors are positive for:^[20]^[21]
- AFP
  - Absence of AFP does not exclude the diagnosis.
- Cytokeratin (AE1/AE3)
- Placental-like alkaline phosphatase in 50% of the individuals.
- SALL4 (nuclear) in > 90% of the cases.
- GPC3

Non-gestational chriocarcinoma

These tumors stain for keratins strongly.^[22]
- AE1
- AE3
- CAM5
Trophoblastic cells are positive for CD10.
Tumor may be positive for:
- GATA3 (nuclear) in 80% of the cases^[23]
- SALL4 (nuclear) in 70% of the cases^[24]
- PLAP and EMA in 50% of the cases^[25]

Polyembryoma

Embryoid body of the tumor may be positive for Glypican3.^[26]

Teratoma

Usually, teratomas are diagnosed histologically and routine use of immunohistochemistry is not needed. However it may be needed in the diagnosis of immature and monodermal types.
Neuronal elements of mature or immature teratomas are positive for:^[27]
- Glial fibrillary acidic protein (GFAP)
- neuron specific enolase (NSE)
- S-100
Monodermal teratoma^[17]
- Carcinoid tumor may be positive for serotonin and hormonal peptides.

References

↑ ^1.0 ^1.1 El-Maarri, Osman; Rijlaarsdam, Martin A.; Tax, David M. J.; Gillis, Ad J. M.; Dorssers, Lambert C. J.; Koestler, Devin C.; de Ridder, Jeroen; Looijenga, Leendert H. J. (2015). “Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors”. PLOS ONE. 10 (4): e0122146. doi:10.1371/journal.pone.0122146. ISSN 1932-6203.
↑ Carcangiu, M. L. (2014). WHO Classification of Tumours of Female Reproductive Organs. Lyon: International Agency for Research on Cancer. ISBN 978-92-832-4487-5.
↑ ^3.0 ^3.1 Vural, F.; Vural, B.; Paksoy, N. (2015). “Vaginal teratoma: A case report and review of the literature”. Journal of Obstetrics and Gynaecology. 35 (7): 757–758. doi:10.3109/01443615.2015.1004525. ISSN 0144-3615.
↑ Linder, David; McCaw, Barbara Kaiser; Hecht, Frederick (1975). “Parthenogenic Origin of Benign Ovarian Teratomas”. New England Journal of Medicine. 292 (2): 63–66. doi:10.1056/NEJM197501092920202. ISSN 0028-4793.
↑ AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). “Pure dysgerminoma of the ovary: a single institutional experience of 65 patients”. Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.
↑ Gordon A, Lipton D, Woodruff JD (October 1981). “Dysgerminoma: a review of 158 cases from the Emil Novak Ovarian Tumor Registry”. Obstet Gynecol. 58 (4): 497–504. PMID 7279343.
↑ Young, Robert H. (2014). “The Yolk Sac Tumor”. International Journal of Surgical Pathology. 22 (8): 677–687. doi:10.1177/1066896914558265. ISSN 1066-8969.
↑ ^8.00 ^8.01 ^8.02 ^8.03 ^8.04 ^8.05 ^8.06 ^8.07 ^8.08 ^8.09 Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). “Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features”. RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.
↑ ^9.0 ^9.1 Kojimahara, Takanobu; Nakahara, Kenji; Takano, Tadao; Yaegashi, Nobuo; Nishiyama, Hiroshi; Fujimori, Keiya; Sato, Naoki; Terada, Yukihiro; Tase, Toru; Yokoyama, Yoshihito; Mizunuma, Hideki; Shoji, Tadahiro; Sugiyama, Toru; Kurachi, Hirohisa (2013). “Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)”. The Tohoku Journal of Experimental Medicine. 230 (4): 211–217. doi:10.1620/tjem.230.211. ISSN 1349-3329.
↑ ^10.0 ^10.1 ^10.2 Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA (June 2000). “DNA copy number changes in malignant ovarian germ cell tumors”. Cancer Res. 60 (11): 3025–30. PMID 10850452.
↑ Dalmau, Josep; Gleichman, Amy J; Hughes, Ethan G; Rossi, Jeffrey E; Peng, Xiaoyu; Lai, Meizan; Dessain, Scott K; Rosenfeld, Myrna R; Balice-Gordon, Rita; Lynch, David R (2008). “Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies”. The Lancet Neurology. 7 (12): 1091–1098. doi:10.1016/S1474-4422(08)70224-2. ISSN 1474-4422.
↑ ^12.0 ^12.1 Kallenberg, GA; Pesce, CM; Norman, B; Ratner, RE; Silverberg, SG (1991). “Ectopic hyperprolactinemia resulting from an ovarian teratoma”. International Journal of Gynecology & Obstetrics. 34 (2): 194–195. doi:10.1016/0020-7292(91)90266-8. ISSN 0020-7292.
↑ Beresford L, Fernandez CV, Cummings E, Sanderson S, Ming-Yu W, Giacomantonio M (April 2003). “Mediastinal polyembryoma associated with Klinefelter syndrome”. J. Pediatr. Hematol. Oncol. 25 (4): 321–3. PMID 12679648.
↑ Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN (May 2003). “Pathology and classification of ovarian tumors”. Cancer. 97 (10 Suppl): 2631–42. doi:10.1002/cncr.11345. PMID 12733128.
↑ Oliva, Esther; Young, Robert H. (2014). “Germ cell tumours of the ovary: selected topics”. Diagnostic Histopathology. 20 (9): 364–375. doi:10.1016/j.mpdhp.2014.07.003. ISSN 1756-2317.
↑ Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). “Retrospective analysis of mature cystic teratomas in a single center and review of the literature”. Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.
↑ ^17.0 ^17.1 ^17.2 Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). “Ovarian Teratomas: Tumor Types and Imaging Characteristics”. RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.
↑ Mature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015
↑ Ulbright TM (February 2005). “Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues”. Mod. Pathol. 18 Suppl 2: S61–79. doi:10.1038/modpathol.3800310. PMID 15761467.
↑ ^20.0 ^20.1 Pectasides, D.; Pectasides, E.; Kassanos, D. (2008). “Germ cell tumors of the ovary”. Cancer Treatment Reviews. 34 (5): 427–441. doi:10.1016/j.ctrv.2008.02.002. ISSN 0305-7372.
↑ Cao, Dengfeng; Guo, Shuangping; Allan, Robert W.; Molberg, Kyle H.; Peng, Yan (2009). “SALL4 Is a Novel Sensitive and Specific Marker of Ovarian Primitive Germ Cell Tumors and Is Particularly Useful in Distinguishing Yolk Sac Tumor From Clear Cell Carcinoma”. The American Journal of Surgical Pathology. 33 (6): 894–904. doi:10.1097/PAS.0b013e318198177d. ISSN 0147-5185.
↑ Ordi J, Romagosa C, Tavassoli FA, Nogales F, Palacin A, Condom E, Torné A, Cardesa A (February 2003). “CD10 expression in epithelial tissues and tumors of the gynecologic tract: a useful marker in the diagnosis of mesonephric, trophoblastic, and clear cell tumors”. Am. J. Surg. Pathol. 27 (2): 178–86. PMID 12548163.
↑ Banet, Natalie; Gown, Allen M.; Shih, Ie-Ming; Kay Li, Qing; Roden, Richard B.S.; Nucci, Marisa R.; Cheng, Liang; Przybycin, Christopher G.; Nasseri-Nik, Niloofar; Wu, Lee-Shu-Fune; Netto, George J.; Ronnett, Brigitte M.; Vang, Russell (2015). “GATA-3 Expression in Trophoblastic Tissues”. The American Journal of Surgical Pathology. 39 (1): 101–108. doi:10.1097/PAS.0000000000000315. ISSN 0147-5185.
↑ Miettinen, Markku; Wang, Zengfeng; McCue, Peter A.; Sarlomo-Rikala, Maarit; Rys, Janusz; Biernat, Wojciech; Lasota, Jerzy; Lee, Yi-Shan (2014). “SALL4 Expression in Germ Cell and Non–Germ Cell Tumors”. The American Journal of Surgical Pathology. 38 (3): 410–420. doi:10.1097/PAS.0000000000000116. ISSN 0147-5185.
↑ Niehans GA, Manivel JC, Copland GT, Scheithauer BW, Wick MR (September 1988). “Immunohistochemistry of germ cell and trophoblastic neoplasms”. Cancer. 62 (6): 1113–23. PMID 2457424.
↑ Preda, Ovidiu; Nicolae, Alina; Aneiros-Fernández, José; Borda, Angela; Nogales, Francisco F (2011). “Glypican 3 is a sensitive, but not a specific, marker for the diagnosis of yolk sac tumours”. Histopathology. 58 (2): 312–314. doi:10.1111/j.1365-2559.2010.03735.x. ISSN 0309-0167.
↑ Takayama, Yoshiyasu; Matsumura, Nozomi; Nobusawa, Sumihito; Ikota, Hayato; Minegishi, Takashi; Yokoo, Hideaki (2015). “Immunophenotypic features of immaturity of neural elements in ovarian teratoma”. Virchows Archiv. 468 (3): 337–343. doi:10.1007/s00428-015-1891-8. ISSN 0945-6317.

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Causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

There are no established causes for ovarian germ cell tumors. However, there are certain risk factors that predispose to increased risk of ovarian germ cell tumors.

Causes

There are no established causes for ovarian germ cell tumors. However, there are certain risk factors that predispose to increased risk of ovarian germ cell tumors. For more information on risk factors, click here.

References

Epidemiology and Demographics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

In USA, the age-adjusted incidence of malignant ovarian germ cell tumor is 0.41 per 100,000 women. Incidence of these tumors increases from 5 years of age, although it may be present during infancy, and this increase continues to peak between the age of 15 to 19 years which is approximately 1.2 per 100,000 women. Another peak incidence of these tumors has been reported among those aged 65 years old or older where teratoma is the most common type observed. The incidence is higher among non-white ethnicity (other than black, especially Hispanic and Asians) followed by white and black individuals. Females are more commonly affected by germ cell tumors than males. These tumors also account for a greater proportion of ovarian tumors in the Asia and Africa.

Epidemiology

Incidence

The malignant ovarian germ cell tumors incidence increses from 5 years of age, although it may be presnt during infancy, and this increase continues to peak between the age of 15 to 19 years which is approximately 1.2 per 100,000 women.^[1]^[2]^[3]
In USA, the age-adjusted incidence of malignant ovarian germ cell tumor is 0.41 per 100,000 women.^[4]
These tumors are less common than ovarian epithelial tumors.


Incidence of Ovarian germ cell tumors
Mature teratoma	The incidence of mature/benign teratoma is between 1.2 to 14.2 cases per 100,000 individuals worldwide.^[5] The germ cell tumors of the ovary consist approximately one-fourth of ovarian neoplasms and a great majority of them are benign.
Dysgerminoma	Age-adjusted incidence of this tumor is 0.109 per 100,000 women-year.^[6] The incidence is greater in those with partial or complete gonadal dysgenesis.^[7]
Yolk sac tumor	Age-adjusted incidence of this tumor is 0.048 per 100,000 women-year.^[6]
Embryonal carcinoma	Age-adjusted incidence of this tumor is 0.014 per 100,000 women-year.^[6]
Choriocarcinom	Age-adjusted incidence of this tumor is 0.008 per 100,000 women-year.^[6]

Prevalence


Prevalence of Ovarian germ cell tumors
Mature teratoma	Mature teratoma is the most common ovarian germ cell tumor and accounts for 95% of ovarian teratomas.^[8]
Dysgerminoma	Dysgerminoma is the second most common ovarian germ cell tumor.^[8] This tumor accounts for less than 1% of all ovarian cancers.^[9]
Mixed germ cell tumor	These tumors accounts for 10% to 20% of malignant ovarian germ cell tumors and are the forth most common tumors. ^[10] The majority of them contain yolk sac tumor as one of the elements.
Embryonal carcinoma	These tumors are very rare, comprising only 1% of ovarian germ cell tumors, and usually are a component of mixed germ cell tumors.^[11]
Endodermal sinus tumor	The pure form of these tumors are the third most common ovarian tumors.^[10]
Non-gestational choriocarcinoma	These tumors comprised less than 1% of malignant ovarian germ cell tumors.^[12]

Demographics

Age

Although The malignant germ cell tumors may be present during the infancy, the has been reported between the age of 15 and 19 years where dysgerminoma is the most common type observed.^[1]^[2]^[3]
In USA the age-adjusted incidence of malignant ovarian germ cell tumor is 0.41 per 100,000 women.^[4]
In those who are aged 9 years old or younger, the incidence has been reported to be 0.1 per 100,000 girls.^[13]
In those between the age of 10 to 19 years old, the incidence has been reported to be 1.1 per 100,000 girls.
Another peak incidence of these tumors has been reported among those aged 65 years old or older where teratoma is the most common type observed.^[3]


Age
Mature teratoma	Patients of all age groups may develop mature teratoma. However, they tend to present between 20 to 30 years of age at a greater extent.^[14]
Immature teratoma	Immature teratoma tends to affect younger patient than mature teratomas (usually the first 2 decades of life).^[15]
Dysgerminoma	Dysgerminoma commonly affects individuals younger than 30 years of age in 85% of cases.^[9] The median age at the time of diagnosis is approximately 19 to 23 years, although it may happen at any age.^[16] The tumor is uncommon prepubertal or postmenopausal.
Yolk sac tumor	They are most common in women in the second and third decades of life and rarely happens after the age 40.^[17]
Embryonal carcinoma	They affect primarily children and young adults.^[16]
Choriocarcinoma	They can be primary (non-gestational) or secondary to pregnancy (gestational).^[16] Primary type affects children and young adults.

Race

Ovarian germ cell tumors has been observed to have higher incidence among non-white ethnicity (other than black, especially Hispanic and Asians) followed by white and black individuals.^[18]
Dysgerminoma has been reported to have two times higher incidence rate among white and other non-whites than among blacks.

Gender

Females are more commonly affected by germ cell tumors than males.^[6]

Region

Germ cell tumors of the ovary account for a greater proportion of ovarian tumors in the Asia and Africa.^[6]
Dysgerminomas has been reported to have high prevalence in India and Japan.^[16]

References

↑ ^1.0 ^1.1 Quirk, Jeffrey T.; Natarajan, Nachimuthu; Mettlin, Curtis J. (2005). “Age-specific ovarian cancer incidence rate patterns in the United States”. Gynecologic Oncology. 99 (1): 248–250. doi:10.1016/j.ygyno.2005.06.052. ISSN 0090-8258.
↑ ^2.0 ^2.1 Møller H, Evans H (January 2003). “Epidemiology of gonadal germ cell cancer in males and females”. APMIS. 111 (1): 43–6, discussion 46–8. PMID 12752232.
↑ ^3.0 ^3.1 ^3.2 dos Santos Silva I, Swerdlow AJ (May 1991). “Ovarian germ cell malignancies in England: epidemiological parallels with testicular cancer”. Br. J. Cancer. 63 (5): 814–8. PMC 1972374. PMID 1645564.
↑ ^4.0 ^4.1 Pectasides, D.; Pectasides, E.; Kassanos, D. (2008). “Germ cell tumors of the ovary”. Cancer Treatment Reviews. 34 (5): 427–441. doi:10.1016/j.ctrv.2008.02.002. ISSN 0305-7372.
↑ Westhoff C, Pike M, Vessey M (July 1988). “Benign ovarian teratomas: a population-based case-control study”. Br. J. Cancer. 58 (1): 93–8. PMC 2246492. PMID 3166898.
↑ ^6.0 ^6.1 ^6.2 ^6.3 ^6.4 ^6.5 Smith, Harriet O.; Berwick, Marianne; Verschraegen, Claire F.; Wiggins, Charles; Lansing, Letitia; Muller, Carolyn Y.; Qualls, Clifford R. (2006). “Incidence and Survival Rates for Female Malignant Germ Cell Tumors”. Obstetrics & Gynecology. 107 (5): 1075–1085. doi:10.1097/01.AOG.0000216004.22588.ce. ISSN 0029-7844.
↑ Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). “Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features”. RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.
↑ ^8.0 ^8.1 Ulbright, Thomas M (2005). “Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues”. Modern Pathology. 18: S61–S79. doi:10.1038/modpathol.3800310. ISSN 0893-3952.
↑ ^9.0 ^9.1 Vicus, Danielle; Beiner, Mario E.; Klachook, Shany; Le, Lisa W.; Laframboise, Stephane; Mackay, Helen (2010). “Pure dysgerminoma of the ovary 35 years on: A single institutional experience”. Gynecologic Oncology. 117 (1): 23–26. doi:10.1016/j.ygyno.2009.12.024. ISSN 0090-8258.
↑ ^10.0 ^10.1 Tewari, K (2000). “Malignant germ cell tumors of the ovary”. Obstetrics & Gynecology. 95 (1): 128–133. doi:10.1016/S0029-7844(99)00470-6. ISSN 0029-7844.
↑ Cheng, Liang; Zhang, Shaobo; Talerman, Aleksander; Roth, Lawrence M. (2010). “Morphologic, immunohistochemical, and fluorescence in situ hybridization study of ovarian embryonal carcinoma with comparison to solid variant of yolk sac tumor and immature teratoma”. Human Pathology. 41 (5): 716–723. doi:10.1016/j.humpath.2009.10.016. ISSN 0046-8177.
↑ Jiao, Lan-zhou; Xiang, Yang; Feng, Feng-zhi; Wan, Xi-run; Zhao, Jun; Cui, Quan-cai; Yang, Xiu-yu (2010). “Clinical Analysis of 21 Cases of Nongestational Ovarian Choriocarcinoma”. International Journal of Gynecological Cancer. 20 (2): 299–302. doi:10.1111/IGC.0b013e3181cc2526. ISSN 1048-891X.
↑ Brookfield, Kathleen F.; Cheung, Michael C.; Koniaris, Leonidas G.; Sola, Juan E.; Fischer, Anne C. (2009). “A Population-Based Analysis of 1037 Malignant Ovarian Tumors in the Pediatric Population”. Journal of Surgical Research. 156 (1): 45–49. doi:10.1016/j.jss.2009.03.069. ISSN 0022-4804.
↑ Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). “Retrospective analysis of mature cystic teratomas in a single center and review of the literature”. Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.
↑ Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). “Ovarian Teratomas: Tumor Types and Imaging Characteristics”. RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.
↑ ^16.0 ^16.1 ^16.2 ^16.3 AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). “Pure dysgerminoma of the ovary: a single institutional experience of 65 patients”. Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.
↑ Kurman RJ, Norris HJ (December 1976). “Endodermal sinus tumor of the ovary: a clinical and pathologic analysis of 71 cases”. Cancer. 38 (6): 2404–19. PMID 63318.
↑ Smith HO, Berwick M, Verschraegen CF, Wiggins C, Lansing L, Muller CY, Qualls CR (May 2006). “Incidence and survival rates for female malignant germ cell tumors”. Obstet Gynecol. 107 (5): 1075–85. doi:10.1097/01.AOG.0000216004.22588.ce. PMID 16648414.

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Risk Factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

Gonadal dysgenesis and androgen insensitivity syndrome are known risk factors for the development of ovarian germ cell tumors. There are also other maternal factors that have been observed to be associated with increased risk of the development of these tumors in daughters. Factors such as maternal use of exogenous hormones, maternal elevated body mass index, and reproductive factors.

Risk Factors

Ovarian germ cell tumors tend to affect individuals with gonadal dysgenesis at a greater extent.^[1]
Maternal hormonal factors are another things associated with the increased risk of the development of ovarian germ cell tumors in daughters. These factors include:^[2]^[3]^[4]
- Maternal use of exogenous hormones (ie, supportive hormones or oral contraceptives)
- Maternal high body mass index
Other reproductive factors also has been observed to be associated with the development of these tumors such as:
- Parity
- Oral contraceptive use
- Age at first and last births

Mature teratoma

Common risk factors in the malignant transformation of mature teratoma include:
- Old age (> 50 years old)^[5]
- Large tumor size (> 10 cm)
- Presence of a solid portion^[6]

Dysgerminoma

Common risk factors in the development of dysgerminoma are gonadal dysgenesis, androgen insensitivity syndrome and gonadoblastoma.^[7]

References

↑ Pleskacova, J.; Hersmus, R.; Oosterhuis, J.W.; Setyawati, B.A.; Faradz, S.M.; Cools, M.; Wolffenbuttel, K.P.; Lebl, J.; Drop, S.L.; Looijenga, L.H. (2010). “Tumor Risk in Disorders of Sex Development”. Sexual Development. 4 (4–5): 259–269. doi:10.1159/000314536. ISSN 1661-5433.
↑ Sharpe, Richard M.; Skakkebaek, Niels E. (2008). “Testicular dysgenesis syndrome: mechanistic insights and potential new downstream effects”. Fertility and Sterility. 89 (2): e33–e38. doi:10.1016/j.fertnstert.2007.12.026. ISSN 0015-0282.
↑ Skakkebæk, N.E.; Rajpert-De Meyts, E.; Main, K.M. (2001). “Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects: Opinion”. Human Reproduction. 16 (5): 972–978. doi:10.1093/humrep/16.5.972. ISSN 1460-2350.
↑ Walker AH, Ross RK, Haile RW, Henderson BE (April 1988). “Hormonal factors and risk of ovarian germ cell cancer in young women”. Br. J. Cancer. 57 (4): 418–22. PMC 2246577. PMID 3390378.
↑ Hackethal A, Brueggmann D, Bohlmann MK, Franke FE, Tinneberg HR, Münstedt K (December 2008). “Squamous-cell carcinoma in mature cystic teratoma of the ovary: systematic review and analysis of published data”. Lancet Oncol. 9 (12): 1173–80. doi:10.1016/S1470-2045(08)70306-1. PMID 19038764.
↑ Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun (2008). “Malignant transformation of mature cystic teratoma of the ovary: Experience at a single institution”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 141 (2): 173–178. doi:10.1016/j.ejogrb.2008.07.032. ISSN 0301-2115.
↑ Kliegman, Robert (2011). Nelson textbook of pediatrics. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1-4377-0755-7.

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Screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]

Overview

According to the US preventive services task force, screening for ovarian cancer is not recommended in asymptomatic women.

Screening

According to the US preventive services task force, screening for ovarian cancer is not recommended in asymptomatic women.^[1]

References

↑ Grossman, David C.; Curry, Susan J.; Owens, Douglas K.; Barry, Michael J.; Davidson, Karina W.; Doubeni, Chyke A.; Epling, John W.; Kemper, Alex R.; Krist, Alex H.; Kurth, Ann E.; Landefeld, C. Seth; Mangione, Carol M.; Phipps, Maureen G.; Silverstein, Michael; Simon, Melissa A.; Tseng, Chien-Wen (2018). “Screening for Ovarian Cancer”. JAMA. 319 (6): 588. doi:10.1001/jama.2017.21926. ISSN 0098-7484.

Differentiating Ovarian germ cell tumor from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

Ovarian germ cell tumor must be differentiated from other diseases that cause ovarian mass, such as Stein-Leventhal syndrome, ovarian teratoma, tubal pregnancy, ovarian epithelial tumors, ovarian sex-cord stromal tumors, and tubo-ovarian abscess.

Differentiating Ovarian Germ Cell Tumor From Other Diseases

Ovarian germ cell tumor must be differentiated from other diseases that cause ovarian mass, such as:^[1]^[2]

Stein-Leventhal syndrome^[1]^[2]^[3]
Tubal pregnancy
Ovarian epithelial tumors
Ovarian sex-cord stromal tumors
Tubo-ovarian abscess

Dysgerminoma and other ovarian germ cell tumors capable of producing B-hCG must be differentiated from other diseases that cause abdominal/pelvic mass and elevated levels of B-hCG.^[3]

Differentiating ovarian germ cell tumors from other diseases on the basis of age of onset, vaginal discharge, and constitutional symptoms

			Symptoms			Physical examination		Lab Findings	Imaging		Immunohistopathology
Diseases		Clinical manifestations						Para-clinical findings				Gold standard	Additional findings
		Age of onset	Symptoms			Physical examination		Para-clinical findings
			pelvic/abdominal pain or pressure	vaginal bleeding/discharge	GI dysturbance	Fever	Tenderness	Lab Findings	CT scan/US	MRI	Immunohistopathology
Gynecologic
Ovarian	Embryonal carcinoma^[4]^[5]^[6]^[7]^[8]	Individuals of any age, especially young adults	+/–	+/–	_	_	_	Elevated concentration of alfa-fetoprotein (AFP)	Decreased echogenicity on the ultrasound imaging	The tumor is large, predominantly solid and unilateral with areas of necrosis and hemorrhage. There may be cystic areas that contains mucoid material.	AFP Cytokeratin (AE1/AE3) Placental-like alkaline phosphatase in 50% of the individuals. SALL4 (nuclear) in > 90% of the cases. GPC3	Biopsy	Tumor is usually a component of ovarian mixed germ cell tumors.
	Gonadoblastoma ^[9]^[10]^[11]^[12]^[13]^[14]	Individuals of any age,but more common prior to 15 years of age	+/–	+/–	_	_	_	Elevated concentration of human chorionic gonadotropin (hCG), in case of coexisting dysgerminoma	Solid mass with focal or extensive calcifications with or without ascites Mass can be complex and have a cystic component Increased echogenicity on the ultrasound imaging	Solid mass with focal or extensive calcifications with or withous ascites Mass can be complex and have a cystic component	NA	Biopsy	Tumor is bilateral in 50% of cases Focal calcification can be present in 80% of individuals
	Follicular cysts ^[15]	Women in reproductive age (15 -45 y/o)	+/–	–	–	–	+/–	High level of estrogen +/–	In US we may see a >3 cm simple cyst with no internal echo and with posterior acoustic enhancement	simple cyst with no internal echo or septa	NA	History/ imaging	It is associated with hyperestrogenism and endometrial hyperplasia
	Theca lutein cysts ^[16]^[17]^[18]	Women in reproductive age (15 -45 y/o)	+/–	–	–	–	+/–	Depends on the underlying etiology	In US we may see bilaterally enlarged ovaries with multiple cysts	Multiple bilateral cysts	Theca interna cell Hyperplasia	History/ imaging	It is associated with hydatidiform moles, choriocarcinoma, diabetes mellitus and clomiphene intake (ovulation induction)
	Serous cystadenoma/carcinoma ^[19]^[20]^[21]^[22]	>55 y/o	+/–	–	–	–	+/–	Elevated levels of serum cancer antigen-125	In US we may see simple or multiloculated cyst In serous cystadenocarcinoma we may see papillary projection inside the cyst In serous cystadenocarcinoma we may see ascites	In Serous cystadenoma we may see a simple cyst with beak sign, hypointense on T1 and hyperintense on T2 In serous cystadenocarcinoma we may see some Solid malignant components inside the cyst with intermediate signal on T1 and T2	Cyst wall consist of benign/malignant Fallopian epithelial layer Psammoma body In serous cystadenocarcinoma we may see papillary projection inside the cyst	Biopsy	Most common ovarian neoplasm
	Mucinous cystadenoma/carcinoma ^[23]^[24]^[25]	>55 y/o	+/–	–	–	–	+/–	Elevated levels of serum cancer antigen-125	In US we may see large simple cyst with septation In mucinous cystadenocarcinoma we may see thickened internal septation with solid components inside the cyst	Stained glass appearance due to variable signal intensity on T1 and T2 The more mucin we have, there is more intensity on T1 and less intensity on T2	Cyst wall consist of columnar endocervical epithelium We may see gelatinous mucin inside the cyst	Biopsy	It may cause pseudomyxoma peritonei
	Endometrioma ^[26]^[27]^[28]	Women in reproductive age (15 -45 y/o)	+	+	+/–	–	+	Iron deficiency anemia Elevated levels of serum cancer antigen-125 Increased levels of interleukin 1, chemoattractant protein-1, and interferon gamma	Complex mass on US Increased Doppler flow because of increased vascularture It may present with catamenial pneumothorax, hemothorax, and lung nodules in CT scan.	hyperintensity on T1-weighted images and a hypointensity on T2-weighted images Powder burn hemorrhages	Chocolate cyst	Laparoscopy	It may cause infertility
	Teratoma ^[29]^[30]^[31]^[32]	10-30 y/o	+/–	–	–	–	+/–	High level of HCG and LDH	In US we may see cystic adnexal mass with mural components and echogenic lesion due to calcification The iceberg sign Dot-dash pattern	We may see evidence of fat components	All three germ layers cell	Biopsy	It may cause ovarian torsion May content thyroid tissue and cause hyperthyroidism In plane radiography we may see calcification due to the presence of tooth in the tumor
	Dysgerminoma ^[33]^[34]	in the second to third decade of life	+	+/–	–	–	+/–	High level of HCG and LDH Hypercalcemia	Multilobulated solid masses	We may see ovarian mass with septation which are hyperintense on T1 and hypo or isointense on T2 imaging	Sheets fried egg appearance cells	Biopsy	Same as male seminoma
	Yolk sac tumor ^[35]^[36]^[37]	Young children Male infants	+	–	–	–	+	High levels of AFP	In US we may see a combination of echogenic and hypoechoic components	Ovarian mass with hemorrhagic areas	Yellow appearance Hemorrhagic Schiller-Duval bodies (glomeruli like structures)	Biopsy	The other name is ovarian endodermal sinus tumor
	Fibroma ^[38]^[39]^[40]	>50 y/o	Pulling sensation in the groin	–	–	–	+/–	High levels of CA-125	In CT scan we may see a unilateral mass with poor contrast enhancement	Low signal intensity on T1 and T2 We may see scattered hyperintense areas due to edema or cystic degeneration	Spindle-shaped fibroblast	Biopsy	It may cause Meigs syndrome (ovarian fibroma, ascites, and hydrothorax) It may cause ovarian torsion It may cause pleural effusion
	Thecoma ^[41]^[42]^[43]	>50 y/o	+/–	Postmenopausal bleeding	–	–	–	High level of estrogen	In US we may see non-specific ovarian mass We may see evidence of endometrial hyperplasia due to increased level of estrogen	Hyperintense on T2 T1 intensity depends on the amount of fibrous tissue (fibrous tissue lead to hypointensity)	Lipid-laden stromal cells with pale, vaculolated cytoplasm	Biopsy	We may see endometrial cancer as e result of hyper-estrogenism We may see ovarian fibrothecoma (mixture of fibroma and thecoma)
	Granulosa cell tumor ^[44]^[45]^[46]^[47]	50-60 y/o	+	Postmenopausal bleeding	+/–	–	–	High level of estrogen and progesteron We may see inhibin, calretinin, and Ki-67 on the surface of granulosa tumor cells	In US we may see solid, cystic, or multiloculated solid and cystic mass	We may see solid, cystic, or multiloculated solid and cystic mass	Call-Exner bodies	Biopsy	In postmenopausal women may cause breast tenderness
	Sertoli-leydig cell tumor ^[48]^[49]	15 to 35 y/o	+/–	–	–	–	–	Elevated serum testosterone level Elevated alpha-fetoprotein	In US we may see unilateral Well-defined hypoechoic lesion	Low T2 signal intensity areas of high signal intensity	Lydig cells (Polygonal pink cells with eosinophilic cytoplasm Sertoli cells (clear vacuolated cytoplasm)	Biopsy	It may cause virilization symptoms and amenorrhea
	Brenner tumor ^[50]^[51]	>55 y/o	+/–	–	–	–	–	–	In US we may see hypoechoic solid mass and calcification	Hypointense on T2 because of fibrous content	Yellow/pale appearance Transitional cell tumor (resembles bladder) Coffee bean nuclei on H&E	Biopsy	Most of the times it’s an accidental finding
Krukenberg tumor ^[52]^[53]	>55 y/o	+/–	–	+/– Based on underlying malignancy	–	–	In case of metastatic GI cancers we may see iron deficiency anemia	Mostly bilateral, complex ovarian lesion In CT scan we may see evidence of concurrent malignancy in other organs	Mostly bilateral, complex ovarian lesion with solid components Internal hyperintensity on T1 and T2 weighted MR images because of mucin Evidence of concurrent malignancy in other organs	Mucin-secreting signet cell	Imaging/ biopsy	The most common primary tumor is in colon, stomach, breast, lung, and contralateral ovary Based on underlying malignancy it may cause pleural effusion
Tubal	tubo-ovarian abscess ^[54]^[55]^[56]^[57]	Young women (15-30 y/o	+	+	–	+	+	High levels of inflammatory markers Leukocytosis	In US we may see multilocular complex lesion mostly bilateral with debry inside	We may see a pelvic mass filled with fluid with thick walls hypointense in T1 and heterogeneous in T2	In abscess aspiration we may see anaerobic organisms	History/ imaging	The most common risk factors are previous PID, diabetes mellitus, intrauterine device and history of uterine surgery
	Ectopic pregnancy ^[58]	Women in reproductive age (15 -45 y/o)	+	+	+/–	–	+	High level of BhCG Progesterone level ≤5 ng/ml	In US we may see empty uterine cavity, tubal ring sign, ring of fire sign (Doppler), extra-uterine fetal heart rate	NA	NA	History/ imaging	Any women in reproductive age presenting with abdominal pain or amenorrhea should be screened for ectopic pregnancy
	Hydrosalpinx ^[59]^[60]^[61]	NA	+	–	–	–	+/–	–	In US we may see tubal longitudinal folds thickening (cogwheel appearance) In CT scan we may see tubular adnexal lesion with fluid attenuation	Dilated Fallopian tube with fluid signal intensity	NA	Imaging	It is associated with endometriosis (haematosalpinx), ovulation induction, pelvic inflammatory disease, post-hysterectomy, tubal ligation, and tubal malignancy It may cause infertility
	Salpingitis ^[62]	Women of reproductive age	+	+	–	+	+	Leukocytosis	In US we may see , edematous and thickened endosalpingeal folds	NA	NA	History/ physical exam	It may cause infertility
	Fallopian tube carcinoma ^[63]	>60 y/o	+	+	+	–	+/–	High levels of CA125	US findings are non specific (complex mass on Fallopian tube We may see papillary projections	Low signal on T1 In case of hemorrhage inside the tumor we may see high signal intensity on T1 Low or of intermediate signal on T2 In case of serous fluid inside the tumor we may see high signal intensity on T2	Based on the tumor type we may have different biopsy finding	Biopsy	We may see Latzko triad (abdominal pain, vaginal discgarge, pelvic mass) It may cause pleural effusion
Uterine	Leiomyoma ^[64]^[65]	Women of reproductive age	+	+	–	–	+/–	In chronic cases, we may see mild anemia	In US we may see hypoechoic mass with calcification and cystic areas of necrosis or degeneration may	Low to intermediate signal intensity on T1 and T2 In case of necrosis inside the mass, there might be some high signal lesions on T2	Smooth muscle	Imaging	It may cause infertility
	Choriocarcinoma ^[66]^[67]^[68]^[69]	Women in reproductive age (15 -45 y/o)	+	+	+/–	–	+	High level of B-hCG	In US we may see heterogeneous mass infiltrating myometrium Enlarged uterus Necrosis + Hemorrhage + In CT scan we may see evidence of metastasis to brain, lung and other organs	We may see an infiltrative uterine mass and thickening of uterine wall	Trophoblastic tissue origin columns and sheets of trophoblastic tissue invading uterine muscle and blood vessels	Biopsy	It is associated with bilateral theca lutein cysts Cannonball metastases to the lungs May cause hemoptysis We may see passing of grapes like tissue from the vagina
	Leiomyosarcoma ^[70]^[71]^[72]^[73]^[74]	>55 y/o	+	+	–	–	+/–	In some cases we may see elevated levels of CA-125 lactate dehydrogenase	Heterogeneous mass with central low attenuation (necrosis) and calcification.	Increased uterine size Irregular central zones of low signal intensity (tumor necrosis)	We may see atypical cells, high mitotic rate, geographic areas of coagulative necrosis separated from viable neoplasm	Biopsy	In case of rapid uterine growth in post menopausal women we may suspect uterine sarcoma
	Pregnancy ^[75]	Women in reproductive age (15 -45 y/o)	+/−	+/−	+/−	–	–	High level of BhCG	In US we may see gestational sac, yolk sac, double bleb sign and fetal pore In CT scan we may see cystic structure filled with fluid, curvilinear enhancing structure (placenta) and fetal pore	Cystic structure filled with fluid Curvilinear enhancing structure (placenta) Fetal pore	NA	History/ laboratory findings	We do not perform CT scan and MRI in pregnancy but We may unintentionally image the pregnancy with CT scan and MRI.
Non-gynecologic
GIT	Appendiceal abscess ^[76]	NA	+	–	+	+/–	+	Leukocytosis	Fluid collection in the appendicular region appendicolith may be visualized.	Fluid collection in the appendicular region appendicolith may be visualized.	NA	Imaging/ history	The most common complication of acute appendicitis It may cause pleural effusion
	Appendiceal neoplasm ^[77]^[78]^[79]^[80]^[81]	60-70 y/o for adenocarcinoma, 30-50 y/o for carcinoid tumors	+	–	+	–	+/–	In adenocarcinoma type we may have high levels of CEA and CA 19-9 In carcinoid type we may see high levels of chromogranin A, 5-HIAA and Ki67	In CT scan we may see: Soft tissue thickening and Cystic lesion with Internal septation Wall irregularity Calcification Peri-appendiceal fat stranding	Soft tissue mass in the appendix We may see invasion to other structures	Gray/yellowi color Cystic structures with angiolymphatic invasion	Biopsy	It is associated with: MEN1 syndrome Ulcerative colitis Neurofibromatosis type 1 HNPCC Smoking It may cause pleural effusion
	Diverticular abscess ^[82]	>50 y/o	+	–	+	+/–	+	Leukocytosis	Ill-defined lesion with air and fluid inside Adjacent bowel loop wall thickening Smudged mesenteric fat	We may see a lesion with air and fluid inside	NA	Imaging/ history	Diverticular abscess happens in almost 30-40% of patients with diverticulitis It may cause pleural effusion
	Colorectal cancer ^[83]^[84]^[85]^[86]	>50 y/o	+	–	+	–	+/–	Anemia Positive Fecal occult blood test High levels of CEA and CA 19-9	In CT scan we may see luminal narrowing, intestinal wall thickening,intussusception, bowel obstruction, hepatic metastases, intestinal perforation,enlarged lymph nodes	We may see tumor mass and the extension of tumor to other structures We may see metastasis to the liver, lung and brain	Based on the sub-type we may have different histopathological feature (for more information click here)	Biopsy	It is associated with smoking, positive family history, processed meat, low fiber diet, lynch Syndrome and familial adenomatous polyposis They have apple core lesion on barium enema xray
Renal Bladder	Pelvic kidney ^[87]^[88]	NA	−/+ In case of sever hydronephrosis or renal stone we may have pelvic pain	–	−	−	−	−	In sonography we may see normal appearing kidney in pelvic position We may see renal calculi	We may see normal kidney structure Renal calculi	NA	Imaging	It may cause hypertension It may cause tract infection (UTI), obstruction, and renal calculi. It may be associated with RCC
Renal Bladder	Bladder cancer ^[89]^[90]^[91]	≥65 y/o	+	–	–	–	–	Low red blood cell count Elevated alkaline phosphatase Positive tumor markers such as BTA, NMP, and CEA	In CT scan we may see masses protruding into the bladder lumen or asymmetric thickening of the bladder calcifications Nodal metastases	isointense compared to muscle in T1 slightly hyperintense compared to muscle in T2	Based on the sub-type we may have different histopathological feature (for more information click here)	Biopsy	It may presents with hematuria
Others	Retroperitoneal sarcoma ^[92]^[93]^[94]^[95]	40-50 y/o	+	–	+	−	−	Mild leukocytosis. It may cause hypoglycemia because of production of insulinlike substances	We may see irregular solid, semisolid, liquefactive areas and patchy necrosis on CT scan	We may see retroperitoneal involvement and degree of tumor extension We may see liver and lung metastasis	There are two types: liposarcoma and leiomyosarcoma In liposarcomas we may see background of adipocytes with scattered lipoblasts, and inflammatory cell infiltrate In leiomyosarcoma we may see smooth muscle cells	Biopsy	May cause lower extremity edema, Serous ascites we should perform chest CT scan to rule out pulmonary metastases

ABBREVIATIONS

BTA=Bladder tumor associated antigen, NMP= Nuclear matrix proteins, CEA= Carcinoembryonic antigen, US= Ultrasound, HCG= Human chorionic gonadotropin, LDH= Lactate dehydrogenase, AFP= Alpha fitoprotein, CA125= Cancer antigen 125, H&E= Hematoxylin and eosin, MRI= Magnetic resonance imaging, GI= Gastrointestinal tract, PID= Pelvic inflammatory disease, CA19-9= Carbohydrate antigen 19-9, 5HIAA= 5-hydroxyindoleacetic acid, MEN syndrome= Multiple endocrine neoplasia syndrome, HNPCC= Hereditary nonpolyposis colorectal cancer, UTI= Urinary tract infection, RCC= Renal cell carcinoma

References

↑ ^1.0 ^1.1 Shaaban AM, Rezvani M, Elsayes KM, et al. Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features. Radiographics. 2014;34(3):777-801.http://pubs.rsna.org/doi/pdf/10.1148/rg.343130067
↑ ^2.0 ^2.1 Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002;22(6):1305-25.http://www.ncbi.nlm.nih.gov/pubmed/12432104
↑ ^3.0 ^3.1 Rozenholc A, Abdulcadir J, Pelte MF, Petignat P (June 2012). “A pelvic mass on ultrasonography and high human chorionic gonadotropin level: not always an ectopic pregnancy”. BMJ Case Rep. 2012. doi:10.1136/bcr.01.2012.5577. PMID 22669919.
↑ Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Søgaard H; et al. (1984). “Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases”. Acta Radiol Oncol. 23 (4): 239–47. PMID 6093440.
↑ Ishida, M.; Hasegawa, M.; Kanao, K.; Oyama, M.; Nakajima, Y. (2008). “Non-palpable Testicular Embryonal Carcinoma Diagnosed by Ultrasound: A Case Report”. Japanese Journal of Clinical Oncology. 39 (2): 124–126. doi:10.1093/jjco/hyn141. ISSN 0368-2811.
↑ Stein, Erica B.; Wasnik, Ashish P.; Sciallis, Andrew P.; Kamaya, Aya; Maturen, Katherine E. (2017). “MR Imaging–Pathologic Correlation in Ovarian Cancer”. Magnetic Resonance Imaging Clinics of North America. 25 (3): 545–562. doi:10.1016/j.mric.2017.03.004. ISSN 1064-9689.
↑ Pectasides, D.; Pectasides, E.; Kassanos, D. (2008). “Germ cell tumors of the ovary”. Cancer Treatment Reviews. 34 (5): 427–441. doi:10.1016/j.ctrv.2008.02.002. ISSN 0305-7372.
↑ Cao, Dengfeng; Guo, Shuangping; Allan, Robert W.; Molberg, Kyle H.; Peng, Yan (2009). “SALL4 Is a Novel Sensitive and Specific Marker of Ovarian Primitive Germ Cell Tumors and Is Particularly Useful in Distinguishing Yolk Sac Tumor From Clear Cell Carcinoma”. The American Journal of Surgical Pathology. 33 (6): 894–904. doi:10.1097/PAS.0b013e318198177d. ISSN 0147-5185.
↑ Scully RE (1970). “Gonadoblastoma. A review of 74 cases”. Cancer. 25 (6): 1340–56. PMID 4193741.
↑ Saia, Philip (2018). Clinical gynecologic oncology. Philadelphia, PA: Elsevier. ISBN 978-0-323-40067-1.
↑ Esin, Sertac; Baser, Eralp; Kucukozkan, Tuncay; Magden, Hasim Ata (2011). “Ovarian gonadoblastoma with dysgerminoma in a 15-year-old girl with 46, XX karyotype: case report and review of the literature”. Archives of Gynecology and Obstetrics. 285 (2): 447–451. doi:10.1007/s00404-011-2073-9. ISSN 0932-0067.
↑ Luisiri, A; Vogler, C; Steinhardt, G; Silberstein, M (1991). “Neonatal cystic testicular gonadoblastoma. Sonographic and pathologic findings”. Journal of Ultrasound in Medicine. 10 (1): 59–61. doi:10.7863/jum.1991.10.1.59. ISSN 0278-4297.
↑ Hatano T, Yoshino Y, Kawashima Y, Shirai H, Iizuka N, Miyazawa Y, Sakata A, Onishi T (March 1999). “Case of gonadoblastoma in a 9-year-old boy without physical abnormalities”. Int. J. Urol. 6 (3): 164–6. PMID 10226831.
↑ Cools, Martine; Stoop, Hans; Kersemaekers, Anne-Marie F.; Drop, Stenvert L. S.; Wolffenbuttel, Katja P.; Bourguignon, Jean-Pierre; Slowikowska-Hilczer, Jolanta; Kula, Krzysztof; Faradz, Sultana M. H.; Oosterhuis, J. Wolter; Looijenga, Leendert H. J. (2006). “Gonadoblastoma Arising in Undifferentiated Gonadal Tissue within Dysgenetic Gonads”. The Journal of Clinical Endocrinology & Metabolism. 91 (6): 2404–2413. doi:10.1210/jc.2005-2554. ISSN 0021-972X.
↑ Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, Coleman B, Depriest P, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow M, Hur HC, Marnach M, Patel MD, Platt LD, Puscheck E, Smith-Bindman R (September 2010). “Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement”. Radiology. 256 (3): 943–54. doi:10.1148/radiol.10100213. PMID 20505067.
↑ Montz FJ, Schlaerth JB, Morrow CP (August 1988). “The natural history of theca lutein cysts”. Obstet Gynecol. 72 (2): 247–51. PMID 2455880.
↑ Southam, Anna L. (1962). “Massive Ovarian Hyperstimulation with Clomiphene Citrate”. JAMA: The Journal of the American Medical Association. 181 (5): 443. doi:10.1001/jama.1962.03050310083018b. ISSN 0098-7484.
↑ Nguyen, K T; Reid, R L; Sauerbrei, E (1986). “Antenatal sonographic detection of a fetal theca lutein cyst: a clue to maternal diabetes mellitus”. Journal of Ultrasound in Medicine. 5 (11): 665–667. doi:10.7863/jum.1986.5.11.665. ISSN 0278-4297.
↑ Jung, Seung Eun; Lee, Jae Mun; Rha, Sung Eun; Byun, Jae Young; Jung, Jung Im; Hahn, Seong Tai (2002). “CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis”. RadioGraphics. 22 (6): 1305–1325. doi:10.1148/rg.226025033. ISSN 0271-5333.
↑ Imai, Shunsuke; Kiyozuka, Yasuhiko; Maeda, Hiroko; Noda, Tuneo; Hosick, Howard L. (1990). “Establishment and Characterization of a Human Ovarian Serous Cystadenocarcinoma Cell Line That Produces the Tumor Markers CA-125 and Tissue Polypeptide Antigen”. Oncology. 47 (2): 177–184. doi:10.1159/000226813. ISSN 0030-2414.
↑ Malpica A, Deavers MT, Lu K, Bodurka DC, Atkinson EN, Gershenson DM, Silva EG (April 2004). “Grading ovarian serous carcinoma using a two-tier system”. Am. J. Surg. Pathol. 28 (4): 496–504. PMID 15087669.
↑ Li J, Fadare O, Xiang L, Kong B, Zheng W (March 2012). “Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis”. J Hematol Oncol. 5: 8. doi:10.1186/1756-8722-5-8. PMID 22405464.
↑ Hoerl HD, Hart WR (December 1998). “Primary ovarian mucinous cystadenocarcinomas: a clinicopathologic study of 49 cases with long-term follow-up”. Am. J. Surg. Pathol. 22 (12): 1449–62. PMID 9850171.
↑ Lee KR, Scully RE (November 2000). “Mucinous tumors of the ovary: a clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with ‘pseudomyxoma peritonei‘“. Am. J. Surg. Pathol. 24 (11): 1447–64. PMID 11075847.
↑ Jung, Seung Eun; Lee, Jae Mun; Rha, Sung Eun; Byun, Jae Young; Jung, Jung Im; Hahn, Seong Tai (2002). “CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis”. RadioGraphics. 22 (6): 1305–1325. doi:10.1148/rg.226025033. ISSN 0271-5333.
↑ Mol BW, Bayram N, Lijmer JG, Wiegerinck MA, Bongers MY, van der Veen F, Bossuyt PM (December 1998). “The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis”. Fertil. Steril. 70 (6): 1101–8. PMID 9848302.
↑ Kinkel, Karen; Frei, Kathrin A.; Balleyguier, Corinne; Chapron, Charles (2005). “Diagnosis of endometriosis with imaging: a review”. European Radiology. 16 (2): 285–298. doi:10.1007/s00330-005-2882-y. ISSN 0938-7994.
↑ de Ziegler, Dominique; Borghese, Bruno; Chapron, Charles (2010). “Endometriosis and infertility: pathophysiology and management”. The Lancet. 376 (9742): 730–738. doi:10.1016/S0140-6736(10)60490-4. ISSN 0140-6736.
↑ Kawai, Michiyasu; Kano, Takeo; Kikkawa, Fumitaka; Morikawa, Yoshimitsu; Oguchi, Hidenori; Nakashima, Nobuo; Ishizuka, Takao; Kuzuya, Kazuo; Ohta, Masahiro; Arii, Yoshitaro; Tomoda, Yutaka (1992). “Seven tumor markers in benign and malignant germ cell tumors of the ovary”. Gynecologic Oncology. 45 (3): 248–253. doi:10.1016/0090-8258(92)90299-X. ISSN 0090-8258.
↑ Dunzendorfer, Thomas; deLAS MORENAS, ANTONIO; Kalir, Tamara; Levin, Robert M. (1999). “Struma Ovarii and Hyperthyroidism”. Thyroid. 9 (5): 499–502. doi:10.1089/thy.1999.9.499. ISSN 1050-7256.
↑ Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). “Ovarian Teratomas: Tumor Types and Imaging Characteristics”. RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.
↑ Saba, Luca; Guerriero, Stefano; Sulcis, Rosa; Virgilio, Bruna; Melis, GianBenedetto; Mallarini, Giorgio (2009). “Mature and immature ovarian teratomas: CT, US and MR imaging characteristics”. European Journal of Radiology. 72 (3): 454–463. doi:10.1016/j.ejrad.2008.07.044. ISSN 0720-048X.
↑ Dgani, R.; Shoham(Schwartz), Z.; Czernobilsky, B.; Kaftori, A.; Borenstein, R.; Lancet, M. (1988). “Lactic dehydrogenase, alkaline phosphatase and human chorionic gonadotropin in a pure ovarian dysgerminoma”. Gynecologic Oncology. 30 (1): 44–50. doi:10.1016/0090-8258(88)90044-3. ISSN 0090-8258.
↑ Tanaka YO, Kurosaki Y, Nishida M, Michishita N, Kuramoto K, Itai Y, Kubo T (1994). “Ovarian dysgerminoma: MR and CT appearance”. J Comput Assist Tomogr. 18 (3): 443–8. PMID 8188914.
↑ Yang, Grace C.H. (2000). “Fine-needle aspiration cytology of Schiller-Duval bodies of yolk-sac tumor”. Diagnostic Cytopathology. 23 (4): 228–232. doi:10.1002/1097-0339(200010)23:4<228::AID-DC2>3.0.CO;2-M. ISSN 8755-1039.
↑ Levitin, A; Haller, K D; Cohen, H L; Zinn, D L; O’Connor, M T (1996). “Endodermal sinus tumor of the ovary: imaging evaluation”. American Journal of Roentgenology. 167 (3): 791–793. doi:10.2214/ajr.167.3.8751702. ISSN 0361-803X.
↑ Talerman, A.; Haije, W. G. (1974). “Alpha-fetoprotein and germ cell tumors: A possible role of yolk sac tumor in production of alpha-fetoprotein”. Cancer. 34 (5): 1722–1726. doi:10.1002/1097-0142(197411)34:5<1722::AID-CNCR2820340521>3.0.CO;2-F. ISSN 0008-543X.
↑ MEIGS JV (May 1954). “Fibroma of the ovary with ascites and hydrothorax; Meigs’ syndrome”. Am. J. Obstet. Gynecol. 67 (5): 962–85. PMID 13148256.
↑ Sivanesaratnam, V.; Dutta, R.; Jayalakshmi, P. (1990). “Ovarian fibroma – clinical and histopathological characteristics”. International Journal of Gynecology & Obstetrics. 33 (3): 243–247. doi:10.1016/0020-7292(90)90009-A. ISSN 0020-7292.
↑ Abad, Antonio; Cazorla, Eduardo; Ruiz, Fernando; Aznar, Ismael; Asins, Enrique; Llixiona, Joaquin (1999). “Meigs’ syndrome with elevated CA125: case report and review of the literature”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 82 (1): 97–99. doi:10.1016/S0301-2115(98)00174-2. ISSN 0301-2115.
↑ Yaghoobian, Jahanguir; Pinck, Robert L. (1983). “Ultrasound findings in thecoma of the ovary”. Journal of Clinical Ultrasound. 11 (2): 91–93. doi:10.1002/jcu.1870110207. ISSN 0091-2751.
↑ Li, Xinchun; Zhang, Weidong; Zhu, Guangbin; Sun, Congpeng; Liu, Qingyu; Shen, Yuechun (2012). “Imaging Features and Pathologic Characteristics of Ovarian Thecoma”. Journal of Computer Assisted Tomography. 36 (1): 46–53. doi:10.1097/RCT.0b013e31823f6186. ISSN 0363-8715.
↑ Proctor, Francis E.; Greeley, Joseph P.; Rathmell, Thomas K. (1951). “Malignant thecoma of the ovary”. American Journal of Obstetrics and Gynecology. 62 (1): 185–192. doi:10.1016/0002-9378(51)91109-X. ISSN 0002-9378.
↑ Pectasides D, Pectasides E, Psyrri A (February 2008). “Granulosa cell tumor of the ovary”. Cancer Treat. Rev. 34 (1): 1–12. doi:10.1016/j.ctrv.2007.08.007. PMID 17945423.
↑ Stenwig, Jan Trygve; Hazekamp, Johan The.; Beecham, Jackson B. (1979). “Granulosa cell tumors of the ovary. A clinicopathological study of 118 cases with long-term follow-up”. Gynecologic Oncology. 7 (2): 136–152. doi:10.1016/0090-8258(79)90090-8. ISSN 0090-8258.
↑ Morikawa K, Hatabu H, Togashi K, Kataoka ML, Mori T, Konishi J (1997). “Granulosa cell tumor of the ovary: MR findings”. J Comput Assist Tomogr. 21 (6): 1001–4. PMID 9386298.
↑ Ko SF, Wan YL, Ng SH, Lee TY, Lin JW, Chen WJ, Kung FT, Tsai CC (May 1999). “Adult ovarian granulosa cell tumors: spectrum of sonographic and CT findings with pathologic correlation”. AJR Am J Roentgenol. 172 (5): 1227–33. doi:10.2214/ajr.172.5.10227493. PMID 10227493.
↑ Lantzsch, T.; Stoerer, S.; Lawrenz, K.; Buchmann, J.; Strauss, H.-G.; Koelbl, H. (2001). “Sertoli-Leydig cell tumor”. Archives of Gynecology and Obstetrics. 264 (4): 206–208. doi:10.1007/s004040000114. ISSN 0932-0067.
↑ Jung, Seung Eun; Rha, Sung Eun; Lee, Jae Mun; Park, Soo Youn; Oh, Soon Nam; Cho, Kyoung Sik; Lee, Eun Ju; Byun, Jae Young; Hahn, Seong Tai (2005). “CT and MRI Findings of Sex Cord–Stromal Tumor of the Ovary”. American Journal of Roentgenology. 185 (1): 207–215. doi:10.2214/ajr.185.1.01850207. ISSN 0361-803X.
↑ Shevchuk, Maria M.; Fenoglio, Cecilia M.; Richart, Ralph M. (1980). “Histogenesis of brenner tumors, I: Histology and ultrastructure”. Cancer. 46 (12): 2607–2616. doi:10.1002/1097-0142(19801215)46:12<2607::AID-CNCR2820461213>3.0.CO;2-Q. ISSN 0008-543X.
↑ Outwater, Eric K; Siegelman, Evan S; Kim, Bohyun; Chiowanich, Peerapod; Blasbalg, Roberto; Kilger, Alex (1998). “Ovarian Brenner tumors: MR imaging characteristics”. Magnetic Resonance Imaging. 16 (10): 1147–1153. doi:10.1016/S0730-725X(98)00136-2. ISSN 0730-725X.
↑ Kim SH, Kim WH, Park KJ, Lee JK, Kim JS (1996). “CT and MR findings of Krukenberg tumors: comparison with primary ovarian tumors”. J Comput Assist Tomogr. 20 (3): 393–8. PMID 8626898.
↑ Al-Agha OM, Nicastri AD (November 2006). “An in-depth look at Krukenberg tumor: an overview”. Arch. Pathol. Lab. Med. 130 (11): 1725–30. doi:10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2. PMID 17076540.
↑ Landers, D. V.; Sweet, R. L. (1983). “Tubo-ovarian Abscess: Contemporary Approach to Management”. Clinical Infectious Diseases. 5 (5): 876–884. doi:10.1093/clinids/5.5.876. ISSN 1058-4838.
↑ Stewart Taylor, E.; McMillan, James H.; Greer, Benjamin E.; Droegemueller, William; Thompson, Horace E. (1975). “The intrauterine device and tubo-ovarian abscess”. American Journal of Obstetrics and Gynecology. 123 (4): 338–348. doi:10.1016/S0002-9378(16)33434-2. ISSN 0002-9378.
↑ Ha, H. K.; Lim, G. Y.; Cha, E. S.; Lee, H. G.; Ro, H. J.; Kim, H. S.; Kim, H. H.; Joo, S. W.; Jee, M. K. (1995). “MR Imaging of Tubo-Ovarian Abscess”. Acta Radiologica. 36 (5): 510–514. doi:10.1080/02841859509173418. ISSN 0284-1851.
↑ Varras M, Polyzos D, Perouli E, Noti P, Pantazis I, Akrivis C (2003). “Tubo-ovarian abscesses: spectrum of sonographic findings with surgical and pathological correlations”. Clin Exp Obstet Gynecol. 30 (2–3): 117–21. PMID 12854857. Vancouver style error: initials (help)
↑ Barnhart, Kurt T. (2009). “Ectopic Pregnancy”. New England Journal of Medicine. 361 (4): 379–387. doi:10.1056/NEJMcp0810384. ISSN 0028-4793.
↑ Kim, Mi Young; Rha, Sung Eun; Oh, Soon Nam; Jung, Seung Eun; Lee, Young Joon; Kim, You Sung; Byun, Jae Young; Lee, Ahwon; Kim, Mee-Ran (2009). “MR Imaging Findings of Hydrosalpinx: A Comprehensive Review”. RadioGraphics. 29 (2): 495–507. doi:10.1148/rg.292085070. ISSN 0271-5333.
↑ Atri M, Nazarnia S, Bret PM, Aldis AE, Kintzen G, Reinhold C (July 1994). “Endovaginal sonographic appearance of benign ovarian masses”. Radiographics. 14 (4): 747–60, discussion 761–2. doi:10.1148/radiographics.14.4.7938766. PMID 7938766.
↑ Chanelles, Olivier; Ducarme, Guillaume; Sifer, Christophe; Hugues, Jean-Noel; Touboul, Cyril; Poncelet, Christophe (2011). “Hydrosalpinx and infertility: what about conservative surgical management?”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 159 (1): 122–126. doi:10.1016/j.ejogrb.2011.07.004. ISSN 0301-2115.
↑ Czerwenka K, Heuss F, Hosmann J, Manavi M, Jelincic D, Kubista E (October 1994). “Salpingitis caused by Chlamydia trachomatis and its significance for infertility”. Acta Obstet Gynecol Scand. 73 (9): 711–5. PMID 7976247.
↑ Niloff, Jonathan M.; Klug, Thomas L.; Schaetzl, Elena; Zurawski, Vincent R.; Knapp, Robert C.; Bast, Robert C. (1984). “Elevation of serum CA125 in carcinomas of the fallopian tube, endometrium, and endocervix”. American Journal of Obstetrics and Gynecology. 148 (8): 1057–1058. doi:10.1016/S0002-9378(84)90444-7. ISSN 0002-9378.
↑ Bulletti, Carlo; De Ziegler, Dominique; Polli, Valeria; Flamigni, Carlo (1999). “The role of leiomyomas in infertility”. The Journal of the American Association of Gynecologic Laparoscopists. 6 (4): 441–445. doi:10.1016/S1074-3804(99)80008-5. ISSN 1074-3804.
↑ Murase, Eiko; Siegelman, Evan S.; Outwater, Eric K.; Perez-Jaffe, Liza A.; Tureck, Richard W. (1999). “Uterine Leiomyomas: Histopathologic Features, MR Imaging Findings, Differential Diagnosis, and Treatment”. RadioGraphics. 19 (5): 1179–1197. doi:10.1148/radiographics.19.5.g99se131179. ISSN 0271-5333.
↑ Seckl, Michael J; Fisher, Rosemary A; Salerno, Giovanni; Rees, Helene; Paradinas, Fernando J; Foskett, Marianne; Newlands, Edward S (2000). “Choriocarcinoma and partial hydatidiform moles”. The Lancet. 356 (9223): 36–39. doi:10.1016/S0140-6736(00)02432-6. ISSN 0140-6736.
↑ Nishikawa, Yoshiki; Kaseki, Shigeaki; Tomoda, Yutaka; Ishizuka, Takao; Asai, Yasumasa; Suzuki, Toshio; Ushijima, Hiroshi (1985). “Histopathologic classification of uterine choriocarcinoma”. Cancer. 55 (5): 1044–1051. doi:10.1002/1097-0142(19850301)55:5<1044::AID-CNCR2820550520>3.0.CO;2-7. ISSN 0008-543X.
↑ Libshitz HI, Baber CE, Hammond CB (April 1977). “The pulmonary metastases of choriocarcinoma”. Obstet Gynecol. 49 (4): 412–6. PMID 558566.
↑ Diouf A, Cissé ML, Laïco A, Ndiaye D, Moreau JC, Diadhiou F (May 2005). “[Sonographic features of gestational choriocarcinoma]”. J Radiol (in French). 86 (5 Pt 1): 469–73. PMID 16114202.
↑ Seki, K.; Hoshihara, T.; Nagata, I. (1992). “Leiomyosarcoma of the Uterus: Ultrasonography and Serum Lactate Dehydrogenase Level”. Gynecologic and Obstetric Investigation. 33 (2): 114–118. doi:10.1159/000294861. ISSN 1423-002X.
↑ Juang CM, Yen MS, Horng HC, Twu NF, Yu HC, Hsu WL (2006). “Potential role of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma”. Eur. J. Gynaecol. Oncol. 27 (4): 370–4. PMID 17009628.
↑ Pattani, Sita J.; Kier, Ruben; Deal, Robert; Luchansky, Edward (1995). “MRI of uterine leiomyosarcoma”. Magnetic Resonance Imaging. 13 (2): 331–333. doi:10.1016/0730-725X(95)93813-5. ISSN 0730-725X.
↑ McLeod, A J; Zornoza, J; Shirkhoda, A (1984). “Leiomyosarcoma: computed tomographic findings”. Radiology. 152 (1): 133–136. doi:10.1148/radiology.152.1.6729102. ISSN 0033-8419.
↑ Robboy, Stanley J.; Bentley, Rex C.; Butnor, Kelly; Anderson, Malcolm C. (2000). “Pathology and Pathophysiology of Uterine Smooth-Muscle Tumors”. Environmental Health Perspectives. 108: 779. doi:10.2307/3454306. ISSN 0091-6765.
↑ Cacctatore, Bruno; Tttttnen, Atla; Stenman, Ulf-Hakan; Ylostalo, Pekka (1990). “Normal early pregnancy: serum hCG levels and vaginal ultrasonography findings”. BJOG: An International Journal of Obstetrics and Gynaecology. 97 (10): 899–903. doi:10.1111/j.1471-0528.1990.tb02444.x. ISSN 1470-0328.
↑ Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C (August 2005). “CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings”. AJR Am J Roentgenol. 185 (2): 406–17. doi:10.2214/ajr.185.2.01850406. PMID 16037513.
↑ Chapter 5: Tumours of the Appendix – IARC. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb2/bb2-chap5.pdf Accessed on January 15, 2019
↑ Goede, A. C.; Caplin, M. E.; Winslet, M. C. (2003). “Carcinoid tumour of the appendix”. British Journal of Surgery. 90 (11): 1317–1322. doi:10.1002/bjs.4375. ISSN 0007-1323.
↑ Pablo Carmignani, C.; Hampton, Regina; E. Sugarbaker, Christina; Chang, David; H. Sugarbaker, Paul (2004). “Utility of CEA and CA 19-9 tumor markers in diagnosis and prognostic assessment of mucinous epithelial cancers of the appendix”. Journal of Surgical Oncology. 87 (4): 162–166. doi:10.1002/jso.20107. ISSN 0022-4790.
↑ Limsui D, Vierkant RA, Tillmans LS, Wang AH, Weisenberger DJ, Laird PW, Lynch CF, Anderson KE, French AJ, Haile RW, Harnack LJ, Potter JD, Slager SL, Smyrk TC, Thibodeau SN, Cerhan JR, Limburg PJ (July 2010). “Cigarette smoking and colorectal cancer risk by molecularly defined subtypes”. J. Natl. Cancer Inst. 102 (14): 1012–22. doi:10.1093/jnci/djq201. PMC 2915616. PMID 20587792.
↑ Duh QY, Hybarger CP, Geist R, Gamsu G, Goodman PC, Gooding GA, Clark OH (July 1987). “Carcinoids associated with multiple endocrine neoplasia syndromes”. Am. J. Surg. 154 (1): 142–8. PMID 2886072.
↑ Hulnick, D H; Megibow, A J; Balthazar, E J; Naidich, D P; Bosniak, M A (1984). “Computed tomography in the evaluation of diverticulitis”. Radiology. 152 (2): 491–495. doi:10.1148/radiology.152.2.6739821. ISSN 0033-8419.
↑ Zhu, Amy; Kaneshiro, Marc; Kaunitz, Jonathan D. (2010). “Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective”. Digestive Diseases and Sciences. 55 (3): 548–559. doi:10.1007/s10620-009-1108-6. ISSN 0163-2116.
↑ Macdonald JS (1999). “Carcinoembryonic antigen screening: pros and cons”. Semin Oncol. 26 (5): 556–60. PMID 10528904.
↑ Haggar FA, Boushey RP (November 2009). “Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors”. Clin Colon Rectal Surg. 22 (4): 191–7. doi:10.1055/s-0029-1242458. PMC 2796096. PMID 21037809.
↑ Taylor AJ, Youker JE (1991). “Imaging in colorectal carcinoma”. Semin Oncol. 18 (2): 99–110. PMID 2014406.
↑ Weizer, Alon Z.; Springhart, W. Patrick; Ekeruo, Wesley O.; Matlaga, Brian R.; Tan, Yeh H.; Assimos, Dean G.; Preminger, Glenn M. (2005). “Ureteroscopic management of renal calculi in anomalous kidneys”. Urology. 65 (2): 265–269. doi:10.1016/j.urology.2004.09.055. ISSN 0090-4295.
↑ Ross, Jonathan H.; Kay, Robert (1998). “URETEROPELVIC JUNCTION OBSTRUCTION IN ANOMALOUS KIDNEYS”. Urologic Clinics of North America. 25 (2): 219–225. doi:10.1016/S0094-0143(05)70010-0. ISSN 0094-0143.
↑ Barentsz JO, Jager GJ, Witjes JA, Ruijs JH (1996). “Primary staging of urinary bladder carcinoma: the role of MRI and a comparison with CT”. Eur Radiol. 6 (2): 129–33. PMID 8797968.
↑ Shariat SF, Karam JA, Lotan Y, Karakiewizc PI (2008). “Critical evaluation of urinary markers for bladder cancer detection and monitoring”. Rev Urol. 10 (2): 120–35. PMC 2483317. PMID 18660854.
↑ Metts MC, Metts JC, Milito SJ, Thomas CR (June 2000). “Bladder cancer: a review of diagnosis and management”. J Natl Med Assoc. 92 (6): 285–94. PMC 2640522. PMID 10918764.
↑ Storm FK, Mahvi DM (July 1991). “Diagnosis and management of retroperitoneal soft-tissue sarcoma”. Ann. Surg. 214 (1): 2–10. PMC 1358407. PMID 2064467.
↑ Francis IR, Cohan RH, Varma DG, Sondak VK (August 2005). “Retroperitoneal sarcomas”. Cancer Imaging. 5: 89–94. doi:10.1102/1470-7330.2005.0019. PMID 16154826.
↑ Silverstein, Murray N.; Wakim, Khalil G.; Bahn, Robert C. (1964). “Hypoglycemia associated with neoplasia”. The American Journal of Medicine. 36 (3): 415–423. doi:10.1016/0002-9343(64)90168-8. ISSN 0002-9343.
↑ Storm FK, Mahvi DM (July 1991). “Diagnosis and management of retroperitoneal soft-tissue sarcoma”. Ann. Surg. 214 (1): 2–10. PMC 1358407. PMID 2064467.

Template:WikiDoc Sources

Natural History, Complications and Prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Monalisa Dmello, M.B,B.S., M.D. [3]

Overview

The prognosis of germ cells of the ovary depends on the type of the tumor and its malignant potentials. Possible complications of benign teratomas are a rupture and ovarian torsion also malignant transformation. Prognosis is generally excellent in the mature teratoma, but in case of simultaneous malignant transformation, the 5-year survival rate of patients is approximately [15-30]%. The 5-year survival rate of the patient even with disseminated dysgerminoma at the time of diagnosis is above 90%. The overall 5-year survival rate for yolk sac tumor, embryonal carcinoma and choriocarcinoma are approximately 80%.

Natural History, Complications, and Prognosis

Natural History

The symptoms of ovarian germ cell tumors usually develop in the teenage years with abdominal pain or fullness, and palpable pelvic/abdominal mass.^[1]

Dysgerminomas

Dysgerminoma may be misdiagnosed with ectopic pregnancy given the presence of pelvic mass accompanied with high serum concentrations of B-hCG.^[2]
These tumors tend to spread late and do so through lymphatic system primarily.^[3]

Yolk sac tumor

These tumors tend to grow rapidly and spread to abdominal/pelvic cavity in early stages.^[4]
They are mostly affects women in their second or third decade of life.^[5]

Embryonal carcinoma

These tumors tend to metastasize early.^[6]
They spread through the lymphatic system.

Choriocarcinoma

These tumors are highly malignant and tend to spread locally and within the abdominal cavity.^[6]
They spread early in the course of the tumor.
Non-gestational choriocarcinomas spread through lymphatic system.
Gestational choriocarcinomas spread through Bloodstream.

Complications

Mature teratoma

Common complications of mature teratoma include:^[7]

Ovarian torsion is the most common complication and affects 5% to 10% of the individuals.
- It happens at a greater extent in:^[8]
  - Younger age (10-19 years)
  - Larger tumors
Rupture in < 4% of the affected individuals.^[7]
- Rupture may be associated with leakage of sebaceous contents of the tumor into the peritoneal cavity and leads to granulomatous peritonitis.^[9]
- This complication is very rare and happens in less than 1% of the affected individuals.
Malignant transformation of the tumor may also happen in approximately 2% of affected individuals.^[10]
- The tumor undergoes malignant transformation to squamous cell carcinoma in 80% of them and to adenocarcinoma in the rest of the cases.

Dysgerminoma

Ovarian torsion and acute abdominal pain may occur in < 10% of the cases.^[11]

Prognosis

Only 3% to 5% of ovarian germ cell tumors are malignant which the majority include:^[12]
- Dysgerminomas
- Immature teratoma
- Yolk sac tumor
  - Pure form
  - Part of a mixed germ cell tumor


Prognosis of ovarian germ cell tumors
Mature teratoma	Prognosis is generally excellent in the mature teratoma, but in case of simultaneous malignant transformation, the 5-year survival rate of patients is approximately [15-30]%.^[13]
Immature teratoma	The prognosis of immature teratoma is favorable.^[14] The overall 5-year survival rate is 90%. The 5-year survival for stages III and IV is 75%. Relapse rate is 20% for grade III tumors.
Dysgerminoma	Depending on the stage of the tumor at the time of diagnosis, the prognosis may vary. However, the prognosis is generally regarded as good.^[15] The 5-year survival rate of the patient even with disseminated disease at the time of diagnosis is above 90%. Recurrence of the tumor may occur within 2-years of diagnosis and is curable. For stage A1 the recurrence rate is approximately 20% in 2-years. Poor prognosis is associated with the following factors:^[6] Large tumor size Bilateral involvement Age< 20 or > 40 years Presence of other germ cell neoplasms
Yolk sac tumor	These tumors are highly malignant and tend to spread early.^[6] The survival rate depends on the stage of the tumor: For Stage I–II is 60–100% For Stage III–IV disease is 50–75% after appropriate chemotherapy. The overall 5-year survival rate is 80%.^[14] Relapse rate is 20% overall.
Embryonal carcinoma	These tumors tend to metastasize early.^[6] The survival rate is similar to yolk sac tumor.
Choriocarcinoma	These tumors are highly malignant and tend to spread locally and within the abdominal cavity.^[6] They spread early in the course of the tumor. Survival rate is improved with combination chemotherapy. The majority of patients do not experience the recurrence except those with non-gestational choriocarcinoma. The overall 5-year survival rate is 80%.^[14] Relapse rate is 20% overall.

References

↑ Low, Jeffrey J.H.; Ilancheran, Arunachalam; Ng, Joseph S. (2012). “Malignant ovarian germ-cell tumours”. Best Practice & Research Clinical Obstetrics & Gynaecology. 26 (3): 347–355. doi:10.1016/j.bpobgyn.2012.01.002. ISSN 1521-6934.
↑ Rozenholc A, Abdulcadir J, Pelte MF, Petignat P (2012). “A pelvic mass on ultrasonography and high human chorionic gonadotropin level: not always an ectopic pregnancy”. BMJ Case Rep. 2012. doi:10.1136/bcr.01.2012.5577. PMC 4543203. PMID 22669919.
↑ Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). “Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features”. RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.
↑ Stein, Erica B.; Wasnik, Ashish P.; Sciallis, Andrew P.; Kamaya, Aya; Maturen, Katherine E. (2017). “MR Imaging–Pathologic Correlation in Ovarian Cancer”. Magnetic Resonance Imaging Clinics of North America. 25 (3): 545–562. doi:10.1016/j.mric.2017.03.004. ISSN 1064-9689.
↑ Kurman RJ, Norris HJ (December 1976). “Endodermal sinus tumor of the ovary: a clinical and pathologic analysis of 71 cases”. Cancer. 38 (6): 2404–19. PMID 63318.
↑ ^6.0 ^6.1 ^6.2 ^6.3 ^6.4 ^6.5 Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN (May 2003). “Pathology and classification of ovarian tumors”. Cancer. 97 (10 Suppl): 2631–42. doi:10.1002/cncr.11345. PMID 12733128.
↑ ^7.0 ^7.1 Ayhan, Ali; Bukulmez, Orhan; Genc, Cuneyt; Karamursel, Burcu S.; Ayhan, Ayse (2000). “Mature cystic teratomas of the ovary: case series from one institution over 34 years”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 88 (2): 153–157. doi:10.1016/S0301-2115(99)00141-4. ISSN 0301-2115.
↑ Kim, Min Jae; Kim, Na Young; Lee, Dong-Yun; Yoon, Byung-Koo; Choi, DooSeok (2011). “Clinical characteristics of ovarian teratoma: age-focused retrospective analysis of 580 cases”. American Journal of Obstetrics and Gynecology. 205 (1): 32.e1–32.e4. doi:10.1016/j.ajog.2011.02.044. ISSN 0002-9378.
↑ Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL (July 1994). “Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature”. Obstet Gynecol. 84 (1): 22–8. PMID 8008317.
↑ Singh P, Yordan EL, Wilbanks GD, Miller AW, Wee A (February 1988). “Malignancy associated with benign cystic teratomas (dermoid cysts) of the ovary”. Singapore Med J. 29 (1): 30–4. PMID 2841767.
↑ AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). “Pure dysgerminoma of the ovary: a single institutional experience of 65 patients”. Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.
↑ Smith, Harriet O.; Berwick, Marianne; Verschraegen, Claire F.; Wiggins, Charles; Lansing, Letitia; Muller, Carolyn Y.; Qualls, Clifford R. (2006). “Incidence and Survival Rates for Female Malignant Germ Cell Tumors”. Obstetrics & Gynecology. 107 (5): 1075–1085. doi:10.1097/01.AOG.0000216004.22588.ce. ISSN 0029-7844.
↑ Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun (2008). “Malignant transformation of mature cystic teratoma of the ovary: Experience at a single institution”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 141 (2): 173–178. doi:10.1016/j.ejogrb.2008.07.032. ISSN 0301-2115.
↑ ^14.0 ^14.1 ^14.2 “HarvardKey Login”.
↑ Vicus, Danielle; Beiner, Mario E.; Klachook, Shany; Le, Lisa W.; Laframboise, Stephane; Mackay, Helen (2010). “Pure dysgerminoma of the ovary 35 years on: A single institutional experience”. Gynecologic Oncology. 117 (1): 23–26. doi:10.1016/j.ygyno.2009.12.024. ISSN 0090-8258.

Diagnosis

Treatment

Case Studies

Case#1

Related chapters

Embryonic stem cells

External Links

Ovarian Germ Cell Tumors

Template:WikiDoc Sources

[pmid11259710-1] Outwater EK, Siegelman ES, Hunt JL (2001). “Ovarian teratomas: tumor types and imaging characteristics”. Radiographics. 21 (2): 475–90. doi:10.1148/radiographics.21.2.g01mr09475. PMID 11259710.

[pmid26894303-2] Meinhold-Heerlein I, Fotopoulou C, Harter P, Kurzeder C, Mustea A, Wimberger P, Hauptmann S, Sehouli J (April 2016). “The new WHO classification of ovarian, fallopian tube, and primary peritoneal cancer and its clinical implications”. Arch. Gynecol. Obstet. 293 (4): 695–700. doi:10.1007/s00404-016-4035-8. PMID 26894303.

[El-MaarriRijlaarsdam2015-1] 1.0 ^1.1 El-Maarri, Osman; Rijlaarsdam, Martin A.; Tax, David M. J.; Gillis, Ad J. M.; Dorssers, Lambert C. J.; Koestler, Devin C.; de Ridder, Jeroen; Looijenga, Leendert H. J. (2015). “Genome Wide DNA Methylation Profiles Provide Clues to the Origin and Pathogenesis of Germ Cell Tumors”. PLOS ONE. 10 (4): e0122146. doi:10.1371/journal.pone.0122146. ISSN 1932-6203.

[2] Carcangiu, M. L. (2014). WHO Classification of Tumours of Female Reproductive Organs. Lyon: International Agency for Research on Cancer. ISBN 978-92-832-4487-5.

[VuralVural2015-3] 3.0 ^3.1 Vural, F.; Vural, B.; Paksoy, N. (2015). “Vaginal teratoma: A case report and review of the literature”. Journal of Obstetrics and Gynaecology. 35 (7): 757–758. doi:10.3109/01443615.2015.1004525. ISSN 0144-3615.

[LinderMcCaw1975-4] Linder, David; McCaw, Barbara Kaiser; Hecht, Frederick (1975). “Parthenogenic Origin of Benign Ovarian Teratomas”. New England Journal of Medicine. 292 (2): 63–66. doi:10.1056/NEJM197501092920202. ISSN 0028-4793.

[AL_HusainiSoudy2012-5] AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). “Pure dysgerminoma of the ovary: a single institutional experience of 65 patients”. Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.

[pmid7279343-6] Gordon A, Lipton D, Woodruff JD (October 1981). “Dysgerminoma: a review of 158 cases from the Emil Novak Ovarian Tumor Registry”. Obstet Gynecol. 58 (4): 497–504. PMID 7279343.

[Young2014-7] Young, Robert H. (2014). “The Yolk Sac Tumor”. International Journal of Surgical Pathology. 22 (8): 677–687. doi:10.1177/1066896914558265. ISSN 1066-8969.

[ShaabanRezvani2014-8] 8.00 ^8.01 ^8.02 ^8.03 ^8.04 ^8.05 ^8.06 ^8.07 ^8.08 ^8.09 Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). “Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features”. RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.

[KojimaharaNakahara2013-9] 9.0 ^9.1 Kojimahara, Takanobu; Nakahara, Kenji; Takano, Tadao; Yaegashi, Nobuo; Nishiyama, Hiroshi; Fujimori, Keiya; Sato, Naoki; Terada, Yukihiro; Tase, Toru; Yokoyama, Yoshihito; Mizunuma, Hideki; Shoji, Tadahiro; Sugiyama, Toru; Kurachi, Hirohisa (2013). “Yolk Sac Tumor of the Ovary: A Retrospective Multicenter Study of 33 Japanese Women by Tohoku Gynecologic Cancer Unit (TGCU)”. The Tohoku Journal of Experimental Medicine. 230 (4): 211–217. doi:10.1620/tjem.230.211. ISSN 1349-3329.

[pmid10850452-10] 10.0 ^10.1 ^10.2 Kraggerud SM, Szymanska J, Abeler VM, Kaern J, Eknaes M, Heim S, Teixeira MR, Tropé CG, Peltomäki P, Lothe RA (June 2000). “DNA copy number changes in malignant ovarian germ cell tumors”. Cancer Res. 60 (11): 3025–30. PMID 10850452.

[DalmauGleichman2008-11] Dalmau, Josep; Gleichman, Amy J; Hughes, Ethan G; Rossi, Jeffrey E; Peng, Xiaoyu; Lai, Meizan; Dessain, Scott K; Rosenfeld, Myrna R; Balice-Gordon, Rita; Lynch, David R (2008). “Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies”. The Lancet Neurology. 7 (12): 1091–1098. doi:10.1016/S1474-4422(08)70224-2. ISSN 1474-4422.

[KallenbergPesce1991-12] 12.0 ^12.1 Kallenberg, GA; Pesce, CM; Norman, B; Ratner, RE; Silverberg, SG (1991). “Ectopic hyperprolactinemia resulting from an ovarian teratoma”. International Journal of Gynecology & Obstetrics. 34 (2): 194–195. doi:10.1016/0020-7292(91)90266-8. ISSN 0020-7292.

[pmid12679648-13] Beresford L, Fernandez CV, Cummings E, Sanderson S, Ming-Yu W, Giacomantonio M (April 2003). “Mediastinal polyembryoma associated with Klinefelter syndrome”. J. Pediatr. Hematol. Oncol. 25 (4): 321–3. PMID 12679648.

[pmid12733128-14] Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN (May 2003). “Pathology and classification of ovarian tumors”. Cancer. 97 (10 Suppl): 2631–42. doi:10.1002/cncr.11345. PMID 12733128.

[OlivaYoung2014-15] Oliva, Esther; Young, Robert H. (2014). “Germ cell tumours of the ovary: selected topics”. Diagnostic Histopathology. 20 (9): 364–375. doi:10.1016/j.mpdhp.2014.07.003. ISSN 1756-2317.

[Yayla_AbideBostancı_Ergen2018-16] Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). “Retrospective analysis of mature cystic teratomas in a single center and review of the literature”. Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.

[OutwaterSiegelman2001-17] 17.0 ^17.1 ^17.2 Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). “Ovarian Teratomas: Tumor Types and Imaging Characteristics”. RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.

[wpp-18] Mature teratoma. http://librepathology.org/wiki/index.php/Teratoma#Mature_teratoma. URL Accessed on November 12, 2015

[pmid15761467-19] Ulbright TM (February 2005). “Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues”. Mod. Pathol. 18 Suppl 2: S61–79. doi:10.1038/modpathol.3800310. PMID 15761467.

[PectasidesPectasides2008-20] 20.0 ^20.1 Pectasides, D.; Pectasides, E.; Kassanos, D. (2008). “Germ cell tumors of the ovary”. Cancer Treatment Reviews. 34 (5): 427–441. doi:10.1016/j.ctrv.2008.02.002. ISSN 0305-7372.

[CaoGuo2009-21] Cao, Dengfeng; Guo, Shuangping; Allan, Robert W.; Molberg, Kyle H.; Peng, Yan (2009). “SALL4 Is a Novel Sensitive and Specific Marker of Ovarian Primitive Germ Cell Tumors and Is Particularly Useful in Distinguishing Yolk Sac Tumor From Clear Cell Carcinoma”. The American Journal of Surgical Pathology. 33 (6): 894–904. doi:10.1097/PAS.0b013e318198177d. ISSN 0147-5185.

[pmid12548163-22] Ordi J, Romagosa C, Tavassoli FA, Nogales F, Palacin A, Condom E, Torné A, Cardesa A (February 2003). “CD10 expression in epithelial tissues and tumors of the gynecologic tract: a useful marker in the diagnosis of mesonephric, trophoblastic, and clear cell tumors”. Am. J. Surg. Pathol. 27 (2): 178–86. PMID 12548163.

[BanetGown2015-23] Banet, Natalie; Gown, Allen M.; Shih, Ie-Ming; Kay Li, Qing; Roden, Richard B.S.; Nucci, Marisa R.; Cheng, Liang; Przybycin, Christopher G.; Nasseri-Nik, Niloofar; Wu, Lee-Shu-Fune; Netto, George J.; Ronnett, Brigitte M.; Vang, Russell (2015). “GATA-3 Expression in Trophoblastic Tissues”. The American Journal of Surgical Pathology. 39 (1): 101–108. doi:10.1097/PAS.0000000000000315. ISSN 0147-5185.

[MiettinenWang2014-24] Miettinen, Markku; Wang, Zengfeng; McCue, Peter A.; Sarlomo-Rikala, Maarit; Rys, Janusz; Biernat, Wojciech; Lasota, Jerzy; Lee, Yi-Shan (2014). “SALL4 Expression in Germ Cell and Non–Germ Cell Tumors”. The American Journal of Surgical Pathology. 38 (3): 410–420. doi:10.1097/PAS.0000000000000116. ISSN 0147-5185.

[pmid2457424-25] Niehans GA, Manivel JC, Copland GT, Scheithauer BW, Wick MR (September 1988). “Immunohistochemistry of germ cell and trophoblastic neoplasms”. Cancer. 62 (6): 1113–23. PMID 2457424.

[PredaNicolae2011-26] Preda, Ovidiu; Nicolae, Alina; Aneiros-Fernández, José; Borda, Angela; Nogales, Francisco F (2011). “Glypican 3 is a sensitive, but not a specific, marker for the diagnosis of yolk sac tumours”. Histopathology. 58 (2): 312–314. doi:10.1111/j.1365-2559.2010.03735.x. ISSN 0309-0167.

[TakayamaMatsumura2015-27] Takayama, Yoshiyasu; Matsumura, Nozomi; Nobusawa, Sumihito; Ikota, Hayato; Minegishi, Takashi; Yokoo, Hideaki (2015). “Immunophenotypic features of immaturity of neural elements in ovarian teratoma”. Virchows Archiv. 468 (3): 337–343. doi:10.1007/s00428-015-1891-8. ISSN 0945-6317.

[QuirkNatarajan2005-1] 1.0 ^1.1 Quirk, Jeffrey T.; Natarajan, Nachimuthu; Mettlin, Curtis J. (2005). “Age-specific ovarian cancer incidence rate patterns in the United States”. Gynecologic Oncology. 99 (1): 248–250. doi:10.1016/j.ygyno.2005.06.052. ISSN 0090-8258.

[pmid12752232-2] 2.0 ^2.1 Møller H, Evans H (January 2003). “Epidemiology of gonadal germ cell cancer in males and females”. APMIS. 111 (1): 43–6, discussion 46–8. PMID 12752232.

[pmid1645564-3] 3.0 ^3.1 ^3.2 dos Santos Silva I, Swerdlow AJ (May 1991). “Ovarian germ cell malignancies in England: epidemiological parallels with testicular cancer”. Br. J. Cancer. 63 (5): 814–8. PMC 1972374. PMID 1645564.

[PectasidesPectasides2008-4] 4.0 ^4.1 Pectasides, D.; Pectasides, E.; Kassanos, D. (2008). “Germ cell tumors of the ovary”. Cancer Treatment Reviews. 34 (5): 427–441. doi:10.1016/j.ctrv.2008.02.002. ISSN 0305-7372.

[pmid3166898-5] Westhoff C, Pike M, Vessey M (July 1988). “Benign ovarian teratomas: a population-based case-control study”. Br. J. Cancer. 58 (1): 93–8. PMC 2246492. PMID 3166898.

[SmithBerwick2006-6] 6.0 ^6.1 ^6.2 ^6.3 ^6.4 ^6.5 Smith, Harriet O.; Berwick, Marianne; Verschraegen, Claire F.; Wiggins, Charles; Lansing, Letitia; Muller, Carolyn Y.; Qualls, Clifford R. (2006). “Incidence and Survival Rates for Female Malignant Germ Cell Tumors”. Obstetrics & Gynecology. 107 (5): 1075–1085. doi:10.1097/01.AOG.0000216004.22588.ce. ISSN 0029-7844.

[ShaabanRezvani2014-7] Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). “Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features”. RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.

[Ulbright2005-8] 8.0 ^8.1 Ulbright, Thomas M (2005). “Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues”. Modern Pathology. 18: S61–S79. doi:10.1038/modpathol.3800310. ISSN 0893-3952.

[VicusBeiner2010-9] 9.0 ^9.1 Vicus, Danielle; Beiner, Mario E.; Klachook, Shany; Le, Lisa W.; Laframboise, Stephane; Mackay, Helen (2010). “Pure dysgerminoma of the ovary 35 years on: A single institutional experience”. Gynecologic Oncology. 117 (1): 23–26. doi:10.1016/j.ygyno.2009.12.024. ISSN 0090-8258.

[Tewari2000-10] 10.0 ^10.1 Tewari, K (2000). “Malignant germ cell tumors of the ovary”. Obstetrics & Gynecology. 95 (1): 128–133. doi:10.1016/S0029-7844(99)00470-6. ISSN 0029-7844.

[ChengZhang2010-11] Cheng, Liang; Zhang, Shaobo; Talerman, Aleksander; Roth, Lawrence M. (2010). “Morphologic, immunohistochemical, and fluorescence in situ hybridization study of ovarian embryonal carcinoma with comparison to solid variant of yolk sac tumor and immature teratoma”. Human Pathology. 41 (5): 716–723. doi:10.1016/j.humpath.2009.10.016. ISSN 0046-8177.

[JiaoXiang2010-12] Jiao, Lan-zhou; Xiang, Yang; Feng, Feng-zhi; Wan, Xi-run; Zhao, Jun; Cui, Quan-cai; Yang, Xiu-yu (2010). “Clinical Analysis of 21 Cases of Nongestational Ovarian Choriocarcinoma”. International Journal of Gynecological Cancer. 20 (2): 299–302. doi:10.1111/IGC.0b013e3181cc2526. ISSN 1048-891X.

[BrookfieldCheung2009-13] Brookfield, Kathleen F.; Cheung, Michael C.; Koniaris, Leonidas G.; Sola, Juan E.; Fischer, Anne C. (2009). “A Population-Based Analysis of 1037 Malignant Ovarian Tumors in the Pediatric Population”. Journal of Surgical Research. 156 (1): 45–49. doi:10.1016/j.jss.2009.03.069. ISSN 0022-4804.

[Yayla_AbideBostancı_Ergen2018-14] Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). “Retrospective analysis of mature cystic teratomas in a single center and review of the literature”. Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.

[OutwaterSiegelman2001-15] Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). “Ovarian Teratomas: Tumor Types and Imaging Characteristics”. RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.

[AL_HusainiSoudy2012-16] 16.0 ^16.1 ^16.2 ^16.3 AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). “Pure dysgerminoma of the ovary: a single institutional experience of 65 patients”. Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.

[pmid63318-17] Kurman RJ, Norris HJ (December 1976). “Endodermal sinus tumor of the ovary: a clinical and pathologic analysis of 71 cases”. Cancer. 38 (6): 2404–19. PMID 63318.

[pmid16648414-18] Smith HO, Berwick M, Verschraegen CF, Wiggins C, Lansing L, Muller CY, Qualls CR (May 2006). “Incidence and survival rates for female malignant germ cell tumors”. Obstet Gynecol. 107 (5): 1075–85. doi:10.1097/01.AOG.0000216004.22588.ce. PMID 16648414.

[PleskacovaHersmus2010-1] Pleskacova, J.; Hersmus, R.; Oosterhuis, J.W.; Setyawati, B.A.; Faradz, S.M.; Cools, M.; Wolffenbuttel, K.P.; Lebl, J.; Drop, S.L.; Looijenga, L.H. (2010). “Tumor Risk in Disorders of Sex Development”. Sexual Development. 4 (4–5): 259–269. doi:10.1159/000314536. ISSN 1661-5433.

[SharpeSkakkebaek2008-2] Sharpe, Richard M.; Skakkebaek, Niels E. (2008). “Testicular dysgenesis syndrome: mechanistic insights and potential new downstream effects”. Fertility and Sterility. 89 (2): e33–e38. doi:10.1016/j.fertnstert.2007.12.026. ISSN 0015-0282.

[SkakkebækRajpert-De_Meyts2001-3] Skakkebæk, N.E.; Rajpert-De Meyts, E.; Main, K.M. (2001). “Testicular dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects: Opinion”. Human Reproduction. 16 (5): 972–978. doi:10.1093/humrep/16.5.972. ISSN 1460-2350.

[pmid3390378-4] Walker AH, Ross RK, Haile RW, Henderson BE (April 1988). “Hormonal factors and risk of ovarian germ cell cancer in young women”. Br. J. Cancer. 57 (4): 418–22. PMC 2246577. PMID 3390378.

[pmid19038764-5] Hackethal A, Brueggmann D, Bohlmann MK, Franke FE, Tinneberg HR, Münstedt K (December 2008). “Squamous-cell carcinoma in mature cystic teratoma of the ovary: systematic review and analysis of published data”. Lancet Oncol. 9 (12): 1173–80. doi:10.1016/S1470-2045(08)70306-1. PMID 19038764.

[ParkKim2008-6] Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun (2008). “Malignant transformation of mature cystic teratoma of the ovary: Experience at a single institution”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 141 (2): 173–178. doi:10.1016/j.ejogrb.2008.07.032. ISSN 0301-2115.

[wqd-7] Kliegman, Robert (2011). Nelson textbook of pediatrics. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1-4377-0755-7.

[GrossmanCurry2018-1] Grossman, David C.; Curry, Susan J.; Owens, Douglas K.; Barry, Michael J.; Davidson, Karina W.; Doubeni, Chyke A.; Epling, John W.; Kemper, Alex R.; Krist, Alex H.; Kurth, Ann E.; Landefeld, C. Seth; Mangione, Carol M.; Phipps, Maureen G.; Silverstein, Michael; Simon, Melissa A.; Tseng, Chien-Wen (2018). “Screening for Ovarian Cancer”. JAMA. 319 (6): 588. doi:10.1001/jama.2017.21926. ISSN 0098-7484.

[sba-1] 1.0 ^1.1 Shaaban AM, Rezvani M, Elsayes KM, et al. Ovarian malignant germ cell tumors: cellular classification and clinical and imaging features. Radiographics. 2014;34(3):777-801.http://pubs.rsna.org/doi/pdf/10.1148/rg.343130067

[ajk-2] 2.0 ^2.1 Jung SE, Lee JM, Rha SE, Byun JY, Jung JI, Hahn ST. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002;22(6):1305-25.http://www.ncbi.nlm.nih.gov/pubmed/12432104

[pmid22669919-3] 3.0 ^3.1 Rozenholc A, Abdulcadir J, Pelte MF, Petignat P (June 2012). “A pelvic mass on ultrasonography and high human chorionic gonadotropin level: not always an ectopic pregnancy”. BMJ Case Rep. 2012. doi:10.1136/bcr.01.2012.5577. PMID 22669919.

[pmid6093440-4] Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Søgaard H; et al. (1984). “Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases”. Acta Radiol Oncol. 23 (4): 239–47. PMID 6093440.

[IshidaHasegawa2008-5] Ishida, M.; Hasegawa, M.; Kanao, K.; Oyama, M.; Nakajima, Y. (2008). “Non-palpable Testicular Embryonal Carcinoma Diagnosed by Ultrasound: A Case Report”. Japanese Journal of Clinical Oncology. 39 (2): 124–126. doi:10.1093/jjco/hyn141. ISSN 0368-2811.

[SteinWasnik2017-6] Stein, Erica B.; Wasnik, Ashish P.; Sciallis, Andrew P.; Kamaya, Aya; Maturen, Katherine E. (2017). “MR Imaging–Pathologic Correlation in Ovarian Cancer”. Magnetic Resonance Imaging Clinics of North America. 25 (3): 545–562. doi:10.1016/j.mric.2017.03.004. ISSN 1064-9689.

[PectasidesPectasides2008-7] Pectasides, D.; Pectasides, E.; Kassanos, D. (2008). “Germ cell tumors of the ovary”. Cancer Treatment Reviews. 34 (5): 427–441. doi:10.1016/j.ctrv.2008.02.002. ISSN 0305-7372.

[CaoGuo2009-8] Cao, Dengfeng; Guo, Shuangping; Allan, Robert W.; Molberg, Kyle H.; Peng, Yan (2009). “SALL4 Is a Novel Sensitive and Specific Marker of Ovarian Primitive Germ Cell Tumors and Is Particularly Useful in Distinguishing Yolk Sac Tumor From Clear Cell Carcinoma”. The American Journal of Surgical Pathology. 33 (6): 894–904. doi:10.1097/PAS.0b013e318198177d. ISSN 0147-5185.

[pmid4193741-9] Scully RE (1970). “Gonadoblastoma. A review of 74 cases”. Cancer. 25 (6): 1340–56. PMID 4193741.

[978-0-323-40067-1-10] Saia, Philip (2018). Clinical gynecologic oncology. Philadelphia, PA: Elsevier. ISBN 978-0-323-40067-1.

[EsinBaser2011-11] Esin, Sertac; Baser, Eralp; Kucukozkan, Tuncay; Magden, Hasim Ata (2011). “Ovarian gonadoblastoma with dysgerminoma in a 15-year-old girl with 46, XX karyotype: case report and review of the literature”. Archives of Gynecology and Obstetrics. 285 (2): 447–451. doi:10.1007/s00404-011-2073-9. ISSN 0932-0067.

[LuisiriVogler1991-12] Luisiri, A; Vogler, C; Steinhardt, G; Silberstein, M (1991). “Neonatal cystic testicular gonadoblastoma. Sonographic and pathologic findings”. Journal of Ultrasound in Medicine. 10 (1): 59–61. doi:10.7863/jum.1991.10.1.59. ISSN 0278-4297.

[pmid10226831-13] Hatano T, Yoshino Y, Kawashima Y, Shirai H, Iizuka N, Miyazawa Y, Sakata A, Onishi T (March 1999). “Case of gonadoblastoma in a 9-year-old boy without physical abnormalities”. Int. J. Urol. 6 (3): 164–6. PMID 10226831.

[CoolsStoop2006-14] Cools, Martine; Stoop, Hans; Kersemaekers, Anne-Marie F.; Drop, Stenvert L. S.; Wolffenbuttel, Katja P.; Bourguignon, Jean-Pierre; Slowikowska-Hilczer, Jolanta; Kula, Krzysztof; Faradz, Sultana M. H.; Oosterhuis, J. Wolter; Looijenga, Leendert H. J. (2006). “Gonadoblastoma Arising in Undifferentiated Gonadal Tissue within Dysgenetic Gonads”. The Journal of Clinical Endocrinology & Metabolism. 91 (6): 2404–2413. doi:10.1210/jc.2005-2554. ISSN 0021-972X.

[pmid20505067-15] Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, Coleman B, Depriest P, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow M, Hur HC, Marnach M, Patel MD, Platt LD, Puscheck E, Smith-Bindman R (September 2010). “Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement”. Radiology. 256 (3): 943–54. doi:10.1148/radiol.10100213. PMID 20505067.

[pmid2455880-16] Montz FJ, Schlaerth JB, Morrow CP (August 1988). “The natural history of theca lutein cysts”. Obstet Gynecol. 72 (2): 247–51. PMID 2455880.

[Southam1962-17] Southam, Anna L. (1962). “Massive Ovarian Hyperstimulation with Clomiphene Citrate”. JAMA: The Journal of the American Medical Association. 181 (5): 443. doi:10.1001/jama.1962.03050310083018b. ISSN 0098-7484.

[NguyenReid1986-18] Nguyen, K T; Reid, R L; Sauerbrei, E (1986). “Antenatal sonographic detection of a fetal theca lutein cyst: a clue to maternal diabetes mellitus”. Journal of Ultrasound in Medicine. 5 (11): 665–667. doi:10.7863/jum.1986.5.11.665. ISSN 0278-4297.

[JungLee20022-19] Jung, Seung Eun; Lee, Jae Mun; Rha, Sung Eun; Byun, Jae Young; Jung, Jung Im; Hahn, Seong Tai (2002). “CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis”. RadioGraphics. 22 (6): 1305–1325. doi:10.1148/rg.226025033. ISSN 0271-5333.

[ImaiKiyozuka1990-20] Imai, Shunsuke; Kiyozuka, Yasuhiko; Maeda, Hiroko; Noda, Tuneo; Hosick, Howard L. (1990). “Establishment and Characterization of a Human Ovarian Serous Cystadenocarcinoma Cell Line That Produces the Tumor Markers CA-125 and Tissue Polypeptide Antigen”. Oncology. 47 (2): 177–184. doi:10.1159/000226813. ISSN 0030-2414.

[pmid15087669-21] Malpica A, Deavers MT, Lu K, Bodurka DC, Atkinson EN, Gershenson DM, Silva EG (April 2004). “Grading ovarian serous carcinoma using a two-tier system”. Am. J. Surg. Pathol. 28 (4): 496–504. PMID 15087669.

[pmid22405464-22] Li J, Fadare O, Xiang L, Kong B, Zheng W (March 2012). “Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis”. J Hematol Oncol. 5: 8. doi:10.1186/1756-8722-5-8. PMID 22405464.

[pmid9850171-23] Hoerl HD, Hart WR (December 1998). “Primary ovarian mucinous cystadenocarcinomas: a clinicopathologic study of 49 cases with long-term follow-up”. Am. J. Surg. Pathol. 22 (12): 1449–62. PMID 9850171.

[pmid11075847-24] Lee KR, Scully RE (November 2000). “Mucinous tumors of the ovary: a clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with ‘pseudomyxoma peritonei‘“. Am. J. Surg. Pathol. 24 (11): 1447–64. PMID 11075847.

[JungLee2002-25] Jung, Seung Eun; Lee, Jae Mun; Rha, Sung Eun; Byun, Jae Young; Jung, Jung Im; Hahn, Seong Tai (2002). “CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis”. RadioGraphics. 22 (6): 1305–1325. doi:10.1148/rg.226025033. ISSN 0271-5333.

[pmid9848302-26] Mol BW, Bayram N, Lijmer JG, Wiegerinck MA, Bongers MY, van der Veen F, Bossuyt PM (December 1998). “The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis”. Fertil. Steril. 70 (6): 1101–8. PMID 9848302.

[KinkelFrei2005-27] Kinkel, Karen; Frei, Kathrin A.; Balleyguier, Corinne; Chapron, Charles (2005). “Diagnosis of endometriosis with imaging: a review”. European Radiology. 16 (2): 285–298. doi:10.1007/s00330-005-2882-y. ISSN 0938-7994.

[de_ZieglerBorghese2010-28] Ziegler, Dominique; Borghese, Bruno; Chapron, Charles (2010). “Endometriosis and infertility: pathophysiology and management”. The Lancet. 376 (9742): 730–738. doi:10.1016/S0140-6736(10)60490-4. ISSN 0140-6736.

[KawaiKano1992-29] Kawai, Michiyasu; Kano, Takeo; Kikkawa, Fumitaka; Morikawa, Yoshimitsu; Oguchi, Hidenori; Nakashima, Nobuo; Ishizuka, Takao; Kuzuya, Kazuo; Ohta, Masahiro; Arii, Yoshitaro; Tomoda, Yutaka (1992). “Seven tumor markers in benign and malignant germ cell tumors of the ovary”. Gynecologic Oncology. 45 (3): 248–253. doi:10.1016/0090-8258(92)90299-X. ISSN 0090-8258.

[DunzendorferdeLAS_MORENAS1999-30] Dunzendorfer, Thomas; deLAS MORENAS, ANTONIO; Kalir, Tamara; Levin, Robert M. (1999). “Struma Ovarii and Hyperthyroidism”. Thyroid. 9 (5): 499–502. doi:10.1089/thy.1999.9.499. ISSN 1050-7256.

[OutwaterSiegelman2001-31] Outwater, Eric K.; Siegelman, Evan S.; Hunt, Jennifer L. (2001). “Ovarian Teratomas: Tumor Types and Imaging Characteristics”. RadioGraphics. 21 (2): 475–490. doi:10.1148/radiographics.21.2.g01mr09475. ISSN 0271-5333.

[SabaGuerriero2009-32] Saba, Luca; Guerriero, Stefano; Sulcis, Rosa; Virgilio, Bruna; Melis, GianBenedetto; Mallarini, Giorgio (2009). “Mature and immature ovarian teratomas: CT, US and MR imaging characteristics”. European Journal of Radiology. 72 (3): 454–463. doi:10.1016/j.ejrad.2008.07.044. ISSN 0720-048X.

[DganiShoham(Schwartz)1988-33] Dgani, R.; Shoham(Schwartz), Z.; Czernobilsky, B.; Kaftori, A.; Borenstein, R.; Lancet, M. (1988). “Lactic dehydrogenase, alkaline phosphatase and human chorionic gonadotropin in a pure ovarian dysgerminoma”. Gynecologic Oncology. 30 (1): 44–50. doi:10.1016/0090-8258(88)90044-3. ISSN 0090-8258.

[pmid8188914-34] Tanaka YO, Kurosaki Y, Nishida M, Michishita N, Kuramoto K, Itai Y, Kubo T (1994). “Ovarian dysgerminoma: MR and CT appearance”. J Comput Assist Tomogr. 18 (3): 443–8. PMID 8188914.

[Yang2000-35] Yang, Grace C.H. (2000). “Fine-needle aspiration cytology of Schiller-Duval bodies of yolk-sac tumor”. Diagnostic Cytopathology. 23 (4): 228–232. doi:10.1002/1097-0339(200010)23:4<228::AID-DC2>3.0.CO;2-M. ISSN 8755-1039.

[LevitinHaller1996-36] Levitin, A; Haller, K D; Cohen, H L; Zinn, D L; O’Connor, M T (1996). “Endodermal sinus tumor of the ovary: imaging evaluation”. American Journal of Roentgenology. 167 (3): 791–793. doi:10.2214/ajr.167.3.8751702. ISSN 0361-803X.

[TalermanHaije1974-37] Talerman, A.; Haije, W. G. (1974). “Alpha-fetoprotein and germ cell tumors: A possible role of yolk sac tumor in production of alpha-fetoprotein”. Cancer. 34 (5): 1722–1726. doi:10.1002/1097-0142(197411)34:5<1722::AID-CNCR2820340521>3.0.CO;2-F. ISSN 0008-543X.

[pmid13148256-38] MEIGS JV (May 1954). “Fibroma of the ovary with ascites and hydrothorax; Meigs’ syndrome”. Am. J. Obstet. Gynecol. 67 (5): 962–85. PMID 13148256.

[SivanesaratnamDutta1990-39] Sivanesaratnam, V.; Dutta, R.; Jayalakshmi, P. (1990). “Ovarian fibroma – clinical and histopathological characteristics”. International Journal of Gynecology & Obstetrics. 33 (3): 243–247. doi:10.1016/0020-7292(90)90009-A. ISSN 0020-7292.

[AbadCazorla1999-40] Abad, Antonio; Cazorla, Eduardo; Ruiz, Fernando; Aznar, Ismael; Asins, Enrique; Llixiona, Joaquin (1999). “Meigs’ syndrome with elevated CA125: case report and review of the literature”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 82 (1): 97–99. doi:10.1016/S0301-2115(98)00174-2. ISSN 0301-2115.

[YaghoobianPinck1983-41] Yaghoobian, Jahanguir; Pinck, Robert L. (1983). “Ultrasound findings in thecoma of the ovary”. Journal of Clinical Ultrasound. 11 (2): 91–93. doi:10.1002/jcu.1870110207. ISSN 0091-2751.

[LiZhang2012-42] Li, Xinchun; Zhang, Weidong; Zhu, Guangbin; Sun, Congpeng; Liu, Qingyu; Shen, Yuechun (2012). “Imaging Features and Pathologic Characteristics of Ovarian Thecoma”. Journal of Computer Assisted Tomography. 36 (1): 46–53. doi:10.1097/RCT.0b013e31823f6186. ISSN 0363-8715.

[ProctorGreeley1951-43] Proctor, Francis E.; Greeley, Joseph P.; Rathmell, Thomas K. (1951). “Malignant thecoma of the ovary”. American Journal of Obstetrics and Gynecology. 62 (1): 185–192. doi:10.1016/0002-9378(51)91109-X. ISSN 0002-9378.

[pmid17945423-44] Pectasides D, Pectasides E, Psyrri A (February 2008). “Granulosa cell tumor of the ovary”. Cancer Treat. Rev. 34 (1): 1–12. doi:10.1016/j.ctrv.2007.08.007. PMID 17945423.

[StenwigHazekamp1979-45] Stenwig, Jan Trygve; Hazekamp, Johan The.; Beecham, Jackson B. (1979). “Granulosa cell tumors of the ovary. A clinicopathological study of 118 cases with long-term follow-up”. Gynecologic Oncology. 7 (2): 136–152. doi:10.1016/0090-8258(79)90090-8. ISSN 0090-8258.

[pmid9386298-46] Morikawa K, Hatabu H, Togashi K, Kataoka ML, Mori T, Konishi J (1997). “Granulosa cell tumor of the ovary: MR findings”. J Comput Assist Tomogr. 21 (6): 1001–4. PMID 9386298.

[pmid10227493-47] Ko SF, Wan YL, Ng SH, Lee TY, Lin JW, Chen WJ, Kung FT, Tsai CC (May 1999). “Adult ovarian granulosa cell tumors: spectrum of sonographic and CT findings with pathologic correlation”. AJR Am J Roentgenol. 172 (5): 1227–33. doi:10.2214/ajr.172.5.10227493. PMID 10227493.

[LantzschStoerer2001-48] Lantzsch, T.; Stoerer, S.; Lawrenz, K.; Buchmann, J.; Strauss, H.-G.; Koelbl, H. (2001). “Sertoli-Leydig cell tumor”. Archives of Gynecology and Obstetrics. 264 (4): 206–208. doi:10.1007/s004040000114. ISSN 0932-0067.

[JungRha2005-49] Jung, Seung Eun; Rha, Sung Eun; Lee, Jae Mun; Park, Soo Youn; Oh, Soon Nam; Cho, Kyoung Sik; Lee, Eun Ju; Byun, Jae Young; Hahn, Seong Tai (2005). “CT and MRI Findings of Sex Cord–Stromal Tumor of the Ovary”. American Journal of Roentgenology. 185 (1): 207–215. doi:10.2214/ajr.185.1.01850207. ISSN 0361-803X.

[ShevchukFenoglio1980-50] Shevchuk, Maria M.; Fenoglio, Cecilia M.; Richart, Ralph M. (1980). “Histogenesis of brenner tumors, I: Histology and ultrastructure”. Cancer. 46 (12): 2607–2616. doi:10.1002/1097-0142(19801215)46:12<2607::AID-CNCR2820461213>3.0.CO;2-Q. ISSN 0008-543X.

[OutwaterSiegelman1998-51] Outwater, Eric K; Siegelman, Evan S; Kim, Bohyun; Chiowanich, Peerapod; Blasbalg, Roberto; Kilger, Alex (1998). “Ovarian Brenner tumors: MR imaging characteristics”. Magnetic Resonance Imaging. 16 (10): 1147–1153. doi:10.1016/S0730-725X(98)00136-2. ISSN 0730-725X.

[pmid8626898-52] Kim SH, Kim WH, Park KJ, Lee JK, Kim JS (1996). “CT and MR findings of Krukenberg tumors: comparison with primary ovarian tumors”. J Comput Assist Tomogr. 20 (3): 393–8. PMID 8626898.

[pmid17076540-53] Al-Agha OM, Nicastri AD (November 2006). “An in-depth look at Krukenberg tumor: an overview”. Arch. Pathol. Lab. Med. 130 (11): 1725–30. doi:10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2. PMID 17076540.

[LandersSweet1983-54] Landers, D. V.; Sweet, R. L. (1983). “Tubo-ovarian Abscess: Contemporary Approach to Management”. Clinical Infectious Diseases. 5 (5): 876–884. doi:10.1093/clinids/5.5.876. ISSN 1058-4838.

[Stewart_TaylorMcMillan1975-55] Stewart Taylor, E.; McMillan, James H.; Greer, Benjamin E.; Droegemueller, William; Thompson, Horace E. (1975). “The intrauterine device and tubo-ovarian abscess”. American Journal of Obstetrics and Gynecology. 123 (4): 338–348. doi:10.1016/S0002-9378(16)33434-2. ISSN 0002-9378.

[HaLim1995-56] Ha, H. K.; Lim, G. Y.; Cha, E. S.; Lee, H. G.; Ro, H. J.; Kim, H. S.; Kim, H. H.; Joo, S. W.; Jee, M. K. (1995). “MR Imaging of Tubo-Ovarian Abscess”. Acta Radiologica. 36 (5): 510–514. doi:10.1080/02841859509173418. ISSN 0284-1851.

[pmid12854857-57] Varras M, Polyzos D, Perouli E, Noti P, Pantazis I, Akrivis C (2003). “Tubo-ovarian abscesses: spectrum of sonographic findings with surgical and pathological correlations”. Clin Exp Obstet Gynecol. 30 (2–3): 117–21. PMID 12854857. Vancouver style error: initials (help)

[Barnhart2009-58] Barnhart, Kurt T. (2009). “Ectopic Pregnancy”. New England Journal of Medicine. 361 (4): 379–387. doi:10.1056/NEJMcp0810384. ISSN 0028-4793.

[KimRha2009-59] Kim, Mi Young; Rha, Sung Eun; Oh, Soon Nam; Jung, Seung Eun; Lee, Young Joon; Kim, You Sung; Byun, Jae Young; Lee, Ahwon; Kim, Mee-Ran (2009). “MR Imaging Findings of Hydrosalpinx: A Comprehensive Review”. RadioGraphics. 29 (2): 495–507. doi:10.1148/rg.292085070. ISSN 0271-5333.

[pmid7938766-60] Atri M, Nazarnia S, Bret PM, Aldis AE, Kintzen G, Reinhold C (July 1994). “Endovaginal sonographic appearance of benign ovarian masses”. Radiographics. 14 (4): 747–60, discussion 761–2. doi:10.1148/radiographics.14.4.7938766. PMID 7938766.

[ChanellesDucarme2011-61] Chanelles, Olivier; Ducarme, Guillaume; Sifer, Christophe; Hugues, Jean-Noel; Touboul, Cyril; Poncelet, Christophe (2011). “Hydrosalpinx and infertility: what about conservative surgical management?”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 159 (1): 122–126. doi:10.1016/j.ejogrb.2011.07.004. ISSN 0301-2115.

[pmid7976247-62] Czerwenka K, Heuss F, Hosmann J, Manavi M, Jelincic D, Kubista E (October 1994). “Salpingitis caused by Chlamydia trachomatis and its significance for infertility”. Acta Obstet Gynecol Scand. 73 (9): 711–5. PMID 7976247.

[NiloffKlug1984-63] Niloff, Jonathan M.; Klug, Thomas L.; Schaetzl, Elena; Zurawski, Vincent R.; Knapp, Robert C.; Bast, Robert C. (1984). “Elevation of serum CA125 in carcinomas of the fallopian tube, endometrium, and endocervix”. American Journal of Obstetrics and Gynecology. 148 (8): 1057–1058. doi:10.1016/S0002-9378(84)90444-7. ISSN 0002-9378.

[BullettiDe_Ziegler1999-64] Bulletti, Carlo; De Ziegler, Dominique; Polli, Valeria; Flamigni, Carlo (1999). “The role of leiomyomas in infertility”. The Journal of the American Association of Gynecologic Laparoscopists. 6 (4): 441–445. doi:10.1016/S1074-3804(99)80008-5. ISSN 1074-3804.

[MuraseSiegelman1999-65] Murase, Eiko; Siegelman, Evan S.; Outwater, Eric K.; Perez-Jaffe, Liza A.; Tureck, Richard W. (1999). “Uterine Leiomyomas: Histopathologic Features, MR Imaging Findings, Differential Diagnosis, and Treatment”. RadioGraphics. 19 (5): 1179–1197. doi:10.1148/radiographics.19.5.g99se131179. ISSN 0271-5333.

[SecklFisher2000-66] Seckl, Michael J; Fisher, Rosemary A; Salerno, Giovanni; Rees, Helene; Paradinas, Fernando J; Foskett, Marianne; Newlands, Edward S (2000). “Choriocarcinoma and partial hydatidiform moles”. The Lancet. 356 (9223): 36–39. doi:10.1016/S0140-6736(00)02432-6. ISSN 0140-6736.

[NishikawaKaseki1985-67] Nishikawa, Yoshiki; Kaseki, Shigeaki; Tomoda, Yutaka; Ishizuka, Takao; Asai, Yasumasa; Suzuki, Toshio; Ushijima, Hiroshi (1985). “Histopathologic classification of uterine choriocarcinoma”. Cancer. 55 (5): 1044–1051. doi:10.1002/1097-0142(19850301)55:5<1044::AID-CNCR2820550520>3.0.CO;2-7. ISSN 0008-543X.

[pmid558566-68] Libshitz HI, Baber CE, Hammond CB (April 1977). “The pulmonary metastases of choriocarcinoma”. Obstet Gynecol. 49 (4): 412–6. PMID 558566.

[pmid16114202-69] Diouf A, Cissé ML, Laïco A, Ndiaye D, Moreau JC, Diadhiou F (May 2005). “[Sonographic features of gestational choriocarcinoma]”. J Radiol (in French). 86 (5 Pt 1): 469–73. PMID 16114202.

[SekiHoshihara1992-70] Seki, K.; Hoshihara, T.; Nagata, I. (1992). “Leiomyosarcoma of the Uterus: Ultrasonography and Serum Lactate Dehydrogenase Level”. Gynecologic and Obstetric Investigation. 33 (2): 114–118. doi:10.1159/000294861. ISSN 1423-002X.

[pmid17009628-71] Juang CM, Yen MS, Horng HC, Twu NF, Yu HC, Hsu WL (2006). “Potential role of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma”. Eur. J. Gynaecol. Oncol. 27 (4): 370–4. PMID 17009628.

[PattaniKier1995-72] Pattani, Sita J.; Kier, Ruben; Deal, Robert; Luchansky, Edward (1995). “MRI of uterine leiomyosarcoma”. Magnetic Resonance Imaging. 13 (2): 331–333. doi:10.1016/0730-725X(95)93813-5. ISSN 0730-725X.

[McLeodZornoza1984-73] McLeod, A J; Zornoza, J; Shirkhoda, A (1984). “Leiomyosarcoma: computed tomographic findings”. Radiology. 152 (1): 133–136. doi:10.1148/radiology.152.1.6729102. ISSN 0033-8419.

[RobboyBentley2000-74] Robboy, Stanley J.; Bentley, Rex C.; Butnor, Kelly; Anderson, Malcolm C. (2000). “Pathology and Pathophysiology of Uterine Smooth-Muscle Tumors”. Environmental Health Perspectives. 108: 779. doi:10.2307/3454306. ISSN 0091-6765.

[CacctatoreTttttnen1990-75] Cacctatore, Bruno; Tttttnen, Atla; Stenman, Ulf-Hakan; Ylostalo, Pekka (1990). “Normal early pregnancy: serum hCG levels and vaginal ultrasonography findings”. BJOG: An International Journal of Obstetrics and Gynaecology. 97 (10): 899–903. doi:10.1111/j.1471-0528.1990.tb02444.x. ISSN 1470-0328.

[pmid16037513-76] Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C (August 2005). “CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings”. AJR Am J Roentgenol. 185 (2): 406–17. doi:10.2214/ajr.185.2.01850406. PMID 16037513.

[WHO-77] Chapter 5: Tumours of the Appendix – IARC. https://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb2/bb2-chap5.pdf Accessed on January 15, 2019

[GoedeCaplin2003-78] Goede, A. C.; Caplin, M. E.; Winslet, M. C. (2003). “Carcinoid tumour of the appendix”. British Journal of Surgery. 90 (11): 1317–1322. doi:10.1002/bjs.4375. ISSN 0007-1323.

[Pablo_CarmignaniHampton2004-79] Pablo Carmignani, C.; Hampton, Regina; E. Sugarbaker, Christina; Chang, David; H. Sugarbaker, Paul (2004). “Utility of CEA and CA 19-9 tumor markers in diagnosis and prognostic assessment of mucinous epithelial cancers of the appendix”. Journal of Surgical Oncology. 87 (4): 162–166. doi:10.1002/jso.20107. ISSN 0022-4790.

[pmid20587792-80] Limsui D, Vierkant RA, Tillmans LS, Wang AH, Weisenberger DJ, Laird PW, Lynch CF, Anderson KE, French AJ, Haile RW, Harnack LJ, Potter JD, Slager SL, Smyrk TC, Thibodeau SN, Cerhan JR, Limburg PJ (July 2010). “Cigarette smoking and colorectal cancer risk by molecularly defined subtypes”. J. Natl. Cancer Inst. 102 (14): 1012–22. doi:10.1093/jnci/djq201. PMC 2915616. PMID 20587792.

[pmid2886072-81] Duh QY, Hybarger CP, Geist R, Gamsu G, Goodman PC, Gooding GA, Clark OH (July 1987). “Carcinoids associated with multiple endocrine neoplasia syndromes”. Am. J. Surg. 154 (1): 142–8. PMID 2886072.

[82] Hulnick, D H; Megibow, A J; Balthazar, E J; Naidich, D P; Bosniak, M A (1984). “Computed tomography in the evaluation of diverticulitis”. Radiology. 152 (2): 491–495. doi:10.1148/radiology.152.2.6739821. ISSN 0033-8419.

[ZhuKaneshiro2010-83] Zhu, Amy; Kaneshiro, Marc; Kaunitz, Jonathan D. (2010). “Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective”. Digestive Diseases and Sciences. 55 (3): 548–559. doi:10.1007/s10620-009-1108-6. ISSN 0163-2116.

[pmid10528904-84] Macdonald JS (1999). “Carcinoembryonic antigen screening: pros and cons”. Semin Oncol. 26 (5): 556–60. PMID 10528904.

[pmid21037809-85] Haggar FA, Boushey RP (November 2009). “Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors”. Clin Colon Rectal Surg. 22 (4): 191–7. doi:10.1055/s-0029-1242458. PMC 2796096. PMID 21037809.

[pmid2014406-86] Taylor AJ, Youker JE (1991). “Imaging in colorectal carcinoma”. Semin Oncol. 18 (2): 99–110. PMID 2014406.

[WeizerSpringhart2005-87] Weizer, Alon Z.; Springhart, W. Patrick; Ekeruo, Wesley O.; Matlaga, Brian R.; Tan, Yeh H.; Assimos, Dean G.; Preminger, Glenn M. (2005). “Ureteroscopic management of renal calculi in anomalous kidneys”. Urology. 65 (2): 265–269. doi:10.1016/j.urology.2004.09.055. ISSN 0090-4295.

[RossKay1998-88] Ross, Jonathan H.; Kay, Robert (1998). “URETEROPELVIC JUNCTION OBSTRUCTION IN ANOMALOUS KIDNEYS”. Urologic Clinics of North America. 25 (2): 219–225. doi:10.1016/S0094-0143(05)70010-0. ISSN 0094-0143.

[pmid8797968-89] Barentsz JO, Jager GJ, Witjes JA, Ruijs JH (1996). “Primary staging of urinary bladder carcinoma: the role of MRI and a comparison with CT”. Eur Radiol. 6 (2): 129–33. PMID 8797968.

[pmid18660854-90] Shariat SF, Karam JA, Lotan Y, Karakiewizc PI (2008). “Critical evaluation of urinary markers for bladder cancer detection and monitoring”. Rev Urol. 10 (2): 120–35. PMC 2483317. PMID 18660854.

[pmid10918764-91] Metts MC, Metts JC, Milito SJ, Thomas CR (June 2000). “Bladder cancer: a review of diagnosis and management”. J Natl Med Assoc. 92 (6): 285–94. PMC 2640522. PMID 10918764.

[pmid2064467-92] Storm FK, Mahvi DM (July 1991). “Diagnosis and management of retroperitoneal soft-tissue sarcoma”. Ann. Surg. 214 (1): 2–10. PMC 1358407. PMID 2064467.

[pmid16154826-93] Francis IR, Cohan RH, Varma DG, Sondak VK (August 2005). “Retroperitoneal sarcomas”. Cancer Imaging. 5: 89–94. doi:10.1102/1470-7330.2005.0019. PMID 16154826.

[SilversteinWakim1964-94] Silverstein, Murray N.; Wakim, Khalil G.; Bahn, Robert C. (1964). “Hypoglycemia associated with neoplasia”. The American Journal of Medicine. 36 (3): 415–423. doi:10.1016/0002-9343(64)90168-8. ISSN 0002-9343.

[pmid20644672-95] Storm FK, Mahvi DM (July 1991). “Diagnosis and management of retroperitoneal soft-tissue sarcoma”. Ann. Surg. 214 (1): 2–10. PMC 1358407. PMID 2064467.

[LowIlancheran2012-1] Low, Jeffrey J.H.; Ilancheran, Arunachalam; Ng, Joseph S. (2012). “Malignant ovarian germ-cell tumours”. Best Practice & Research Clinical Obstetrics & Gynaecology. 26 (3): 347–355. doi:10.1016/j.bpobgyn.2012.01.002. ISSN 1521-6934.

[pmid22669919-2] Rozenholc A, Abdulcadir J, Pelte MF, Petignat P (2012). “A pelvic mass on ultrasonography and high human chorionic gonadotropin level: not always an ectopic pregnancy”. BMJ Case Rep. 2012. doi:10.1136/bcr.01.2012.5577. PMC 4543203. PMID 22669919.

[ShaabanRezvani2014-3] Shaaban, Akram M.; Rezvani, Maryam; Elsayes, Khaled M.; Baskin, Henry; Mourad, Amr; Foster, Bryan R.; Jarboe, Elke A.; Menias, Christine O. (2014). “Ovarian Malignant Germ Cell Tumors: Cellular Classification and Clinical and Imaging Features”. RadioGraphics. 34 (3): 777–801. doi:10.1148/rg.343130067. ISSN 0271-5333.

[SteinWasnik2017-4] Stein, Erica B.; Wasnik, Ashish P.; Sciallis, Andrew P.; Kamaya, Aya; Maturen, Katherine E. (2017). “MR Imaging–Pathologic Correlation in Ovarian Cancer”. Magnetic Resonance Imaging Clinics of North America. 25 (3): 545–562. doi:10.1016/j.mric.2017.03.004. ISSN 1064-9689.

[pmid63318-5] Kurman RJ, Norris HJ (December 1976). “Endodermal sinus tumor of the ovary: a clinical and pathologic analysis of 71 cases”. Cancer. 38 (6): 2404–19. PMID 63318.

[pmid12733128-6] 6.0 ^6.1 ^6.2 ^6.3 ^6.4 ^6.5 Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN (May 2003). “Pathology and classification of ovarian tumors”. Cancer. 97 (10 Suppl): 2631–42. doi:10.1002/cncr.11345. PMID 12733128.

[AyhanBukulmez2000-7] 7.0 ^7.1 Ayhan, Ali; Bukulmez, Orhan; Genc, Cuneyt; Karamursel, Burcu S.; Ayhan, Ayse (2000). “Mature cystic teratomas of the ovary: case series from one institution over 34 years”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 88 (2): 153–157. doi:10.1016/S0301-2115(99)00141-4. ISSN 0301-2115.

[KimKim2011-8] Kim, Min Jae; Kim, Na Young; Lee, Dong-Yun; Yoon, Byung-Koo; Choi, DooSeok (2011). “Clinical characteristics of ovarian teratoma: age-focused retrospective analysis of 580 cases”. American Journal of Obstetrics and Gynecology. 205 (1): 32.e1–32.e4. doi:10.1016/j.ajog.2011.02.044. ISSN 0002-9378.

[pmid8008317-9] Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL (July 1994). “Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature”. Obstet Gynecol. 84 (1): 22–8. PMID 8008317.

[pmid2841767-10] Singh P, Yordan EL, Wilbanks GD, Miller AW, Wee A (February 1988). “Malignancy associated with benign cystic teratomas (dermoid cysts) of the ovary”. Singapore Med J. 29 (1): 30–4. PMID 2841767.

[AL_HusainiSoudy2012-11] AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). “Pure dysgerminoma of the ovary: a single institutional experience of 65 patients”. Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.

[SmithBerwick2006-12] Smith, Harriet O.; Berwick, Marianne; Verschraegen, Claire F.; Wiggins, Charles; Lansing, Letitia; Muller, Carolyn Y.; Qualls, Clifford R. (2006). “Incidence and Survival Rates for Female Malignant Germ Cell Tumors”. Obstetrics & Gynecology. 107 (5): 1075–1085. doi:10.1097/01.AOG.0000216004.22588.ce. ISSN 0029-7844.

[ParkKim2008-13] Park, Jeong-Yeol; Kim, Dae-Yeon; Kim, Jong-Hyeok; Kim, Yong-Man; Kim, Young-Tak; Nam, Joo-Hyun (2008). “Malignant transformation of mature cystic teratoma of the ovary: Experience at a single institution”. European Journal of Obstetrics & Gynecology and Reproductive Biology. 141 (2): 173–178. doi:10.1016/j.ejogrb.2008.07.032. ISSN 0301-2115.

[urlHarvardKey_Login-14] 14.0 ^14.1 ^14.2 “HarvardKey Login”.

[VicusBeiner2010-15] Vicus, Danielle; Beiner, Mario E.; Klachook, Shany; Le, Lisa W.; Laframboise, Stephane; Mackay, Helen (2010). “Pure dysgerminoma of the ovary 35 years on: A single institutional experience”. Gynecologic Oncology. 117 (1): 23–26. doi:10.1016/j.ygyno.2009.12.024. ISSN 0090-8258.

[1]

[2]

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[1]

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

[37]

[38]

[39]

[40]

[41]

[42]

[43]

[44]

[45]