Ovarian Sarcoma: Difference between revisions

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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan/US
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan/US
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
|-
! colspan="14" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Gynecologic
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Serous cystadenoma/carcinoma<br><ref name="JungLee20022">{{cite journal|last1=Jung|first1=Seung Eun|last2=Lee|first2=Jae Mun|last3=Rha|first3=Sung Eun|last4=Byun|first4=Jae Young|last5=Jung|first5=Jung Im|last6=Hahn|first6=Seong Tai|title=CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis|journal=RadioGraphics|volume=22|issue=6|year=2002|pages=1305–1325|issn=0271-5333|doi=10.1148/rg.226025033}}</ref><ref name="ImaiKiyozuka1990">{{cite journal|last1=Imai|first1=Shunsuke|last2=Kiyozuka|first2=Yasuhiko|last3=Maeda|first3=Hiroko|last4=Noda|first4=Tuneo|last5=Hosick|first5=Howard L.|title=Establishment and Characterization of a Human Ovarian Serous Cystadenocarcinoma Cell Line That Produces the Tumor Markers CA-125 and Tissue Polypeptide Antigen|journal=Oncology|volume=47|issue=2|year=1990|pages=177–184|issn=0030-2414|doi=10.1159/000226813}}</ref><ref name="pmid15087669">{{cite journal |vauthors=Malpica A, Deavers MT, Lu K, Bodurka DC, Atkinson EN, Gershenson DM, Silva EG |title=Grading ovarian serous carcinoma using a two-tier system |journal=Am. J. Surg. Pathol. |volume=28 |issue=4 |pages=496–504 |date=April 2004 |pmid=15087669 |doi= |url=}}</ref><ref name="pmid22405464">{{cite journal |vauthors=Li J, Fadare O, Xiang L, Kong B, Zheng W |title=Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis |journal=J Hematol Oncol |volume=5 |issue= |pages=8 |date=March 2012 |pmid=22405464 |doi=10.1186/1756-8722-5-8 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Serous cystadenoma/carcinoma<br><ref name="JungLee20022">{{cite journal|last1=Jung|first1=Seung Eun|last2=Lee|first2=Jae Mun|last3=Rha|first3=Sung Eun|last4=Byun|first4=Jae Young|last5=Jung|first5=Jung Im|last6=Hahn|first6=Seong Tai|title=CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis|journal=RadioGraphics|volume=22|issue=6|year=2002|pages=1305–1325|issn=0271-5333|doi=10.1148/rg.226025033}}</ref><ref name="ImaiKiyozuka1990">{{cite journal|last1=Imai|first1=Shunsuke|last2=Kiyozuka|first2=Yasuhiko|last3=Maeda|first3=Hiroko|last4=Noda|first4=Tuneo|last5=Hosick|first5=Howard L.|title=Establishment and Characterization of a Human Ovarian Serous Cystadenocarcinoma Cell Line That Produces the Tumor Markers CA-125 and Tissue Polypeptide Antigen|journal=Oncology|volume=47|issue=2|year=1990|pages=177–184|issn=0030-2414|doi=10.1159/000226813}}</ref><ref name="pmid15087669">{{cite journal |vauthors=Malpica A, Deavers MT, Lu K, Bodurka DC, Atkinson EN, Gershenson DM, Silva EG |title=Grading ovarian serous carcinoma using a two-tier system |journal=Am. J. Surg. Pathol. |volume=28 |issue=4 |pages=496–504 |date=April 2004 |pmid=15087669 |doi= |url=}}</ref><ref name="pmid22405464">{{cite journal |vauthors=Li J, Fadare O, Xiang L, Kong B, Zheng W |title=Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis |journal=J Hematol Oncol |volume=5 |issue= |pages=8 |date=March 2012 |pmid=22405464 |doi=10.1186/1756-8722-5-8 |url=}}</ref>

Revision as of 16:52, 18 July 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]

Overview

Ovarian carcinosarcoma, which is also known as a malignant mixed mullerian tumor (MMMT) of the ovary, is a rare, aggressive cancer of the ovary with two distinct characteristic cancer types i.e carcinoma and sarcoma.

Historical Perspective

[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].

The association between [important risk factor/cause] and [disease name] was made in/during [year/event].

In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].

In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].

There have been several outbreaks of [disease name], including -----.

In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].

Classification

  • There is no established system for the classification of ovarian Sarcoma.[1]
  • Primary ovarian sarcomas occur as pure sarcomas or mixed müllerian tumors (MMTs).
  • Pure sarcomas are comprised of a single malignant mesenchymal element and are further categorized as:
    • Stromal cell sarcomas
    • Fibrosarcomas
    • Leiomyosarcomas
    • Neurofibrosarcomas
    • Rhabdomyosarcomas
    • Chondrosarcomas
    • Angiosarcomas
    • Liposarcomas
  • On the other hand mixed mullerian tumors(MMTs) are defined by the presence of both carcinomatous and sarcomatous elements and are more common than pure sarcomas.
  • Ovarian MMTs can be further classified as homologous or heterologous on the basis of the tissue components present.
  • Homologous tumors contain elements that are native to the ovary whereas heterologous tumors contain elements that normally are not present in the ovary.

The staging of [malignancy name] is based on the [staging system].

OR

There is no established system for the staging of [malignancy name].

Pathophysiology

  • The exact pathogenesis of ovarian sarcoma is not fully understood
  • Clonal loss of the wild-type BRCA2 allele as well as the same somatic mutation of the TP53 gene was evident in histologic components


Causes

Disease name] may be caused by [cause1], [cause2], or [cause3].

OR

Common causes of [disease] include [cause1], [cause2], and [cause3].

OR

The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].

OR

The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.

Differentiating ovarian sarcoma from Other Diseases

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Age of onset Symptoms Physical examination
Lab Findings Imaging Immunohistopathology
pelvic/abdominal pain or pressure vaginal bleeding/discharge GI dysturbance Fever Tenderness CT scan/US MRI
Serous cystadenoma/carcinoma
[2][3][4][5]
  • >55 y/o
+/– +/–
  • 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
Mucinous cystadenoma/carcinoma
[6][7][8]
  • >55 y/o
+/– +/–
  • 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
Endometrioma
[9][10][11]
+ + +/– +
  • hyperintensity on T1-weighted images and a hypointensity on T2-weighted images
  • Powder burn hemorrhages
Teratoma
[12][13][14][15]


  • 10-30 y/o
+/– +/–
  • We may see evidence of fat components
Dysgerminoma
[16][17]
  • in the second to third decade of life
+ +/– +/–
  • We may see ovarian mass with septation which are hyperintense on T1 and hypo or isointense on T2 imaging
  • Sheets fried egg appearance cells
Yolk sac tumor
[18][19][20]
+ +
  • High levels of AFP
  • In US we may see a combination of echogenic and hypoechoic components
  • Yellow appearance
  • Schiller-Duval bodies (glomeruli like structures)
Fibroma
[21][22][23]
  • >50 y/o
  • Pulling sensation in the groin
+/–
  • In CT scan we may see a unilateral mass with poor contrast enhancement
  • Low signal intensity on T1 and T2
Thecoma
[24][25][26]
  • >50 y/o
+/–
Granulosa cell tumor
[27][28][29][30]
  • 50-60 y/o
+ +/–
Sertoli-leydig cell tumor
[31][32]
  • 15 to 35 y/o
+/–
  • In US we may see unilateral Well-defined hypoechoic lesion
  • Low T2 signal intensity
  • areas of high signal intensity
Brenner tumor
[33][34]
  • >55 y/o
+/–
  • Hypointense on T2 because of fibrous content
  • Most of the times it's an accidental finding
Krukenberg tumor
[35][36]
  • >55 y/o
+/– +/–

Based on underlying malignancy

Tubal tubo-ovarian abscess
[37][38][39][40]
+ + + +
  • hypointense in T1 and heterogeneous in T2
Ectopic pregnancy
[41]
+ + +/– +
  • NA
  • NA
Hydrosalpinx
[42][43][44]
  • NA
+ +/–
  • NA
Salpingitis
[45]
+ + + +
  • In US we may see , edematous and thickened endosalpingeal folds
  • NA
  • NA
Fallopian tube carcinoma
[46]
  • >60 y/o
+ + + +/–
  • 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
  • Based on the tumor type we may have different biopsy finding
Uterine Leiomyoma
[47][48]
+ + +/–
  • 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
Choriocarcinoma
[49][50][51][52]
+ + +/– +
  • We may see an infiltrative uterine mass and thickening of uterine wall
Leiomyosarcoma
[53][54][55][56][57]
  • >55 y/o
+ + +/–
  • Increased uterine size
  • Irregular central zones of low signal intensity (tumor necrosis)
Pregnancy
[58]
+/− +/− +/−
  • NA
Non-gynecologic


OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Epidemiology and Demographics

  • Ovarian sarcoma is one of the least common gynecologic malignancy, constituting approximately 1% of all ovarian malignancies.[1]


The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.

OR

In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.

OR

In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.


  • Patients of all age groups may develop sarcoma of the ovary both postmenopausal and premenopausal women.

OR

The incidence of ovarian Sarcoma increases with age; the median age at diagnosis is 50-60 years.

OR

[Disease name] commonly affects individuals younger than/older than [number of years] years of age.

OR

[Chronic disease name] is usually first diagnosed among [age group].

OR

[Acute disease name] commonly affects [age group].


There is no racial predilection to [disease name].

OR

[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].


[Disease name] affects men and women equally.

OR

[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.


The majority of [disease name] cases are reported in [geographical region].

OR

[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].

Risk Factors

There are no established risk factors for [disease name].

OR

The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].

OR

Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.

Screening

There is insufficient evidence to recommend routine screening for [disease/malignancy].

OR

According to the [guideline name], screening for [disease name] is not recommended.

OR

According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].

Natural History, Complications, and Prognosis

If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].

OR

Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].

OR

Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.


Diagnostic Study of Choice

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

History and Symptoms

Most of the women are asymptomatic, when present, symptoms may include:[59][60][61]

  • Pain in the abdomen or pelvic area
  • Bloating or swelling of the abdomen
  • Quickly feeling full when eating
  • Other digestive problems

Physical Examination

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Laboratory Findings

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Electrocardiogram

There are no ECG findings associated with [disease name].

OR

An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

X-ray

There are no x-ray findings associated with [disease name].

OR

An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with [disease name].

OR

Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

CT scan

There are no CT scan findings associated with [disease name].

OR

[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

MRI

There are no MRI findings associated with [disease name].

OR

[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].

Other Imaging Findings

There are no other imaging findings associated with [disease name].

OR

[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

Other Diagnostic Studies

There are no other diagnostic studies associated with [disease name].

OR

[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].

Treatment

Medical Therapy

There is no treatment for [disease name]; the mainstay of therapy is supportive care.

OR

Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].

OR

The majority of cases of [disease name] are self-limited and require only supportive care.

OR

[Disease name] is a medical emergency and requires prompt treatment.

OR

The mainstay of treatment for [disease name] is [therapy].

OR The optimal therapy for [malignancy name] depends on the stage at diagnosis.

OR

[Therapy] is recommended among all patients who develop [disease name].

OR

Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].

OR

Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].

OR

Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].

OR

Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].

Surgery

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Primary Prevention

There are no established measures for the primary prevention of [disease name].

OR

There are no available vaccines against [disease name].

OR

Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].

OR

[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].

Secondary Prevention

There are no established measures for the secondary prevention of [disease name].

OR

Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].

References

  1. 1.0 1.1 Harris, M A; Delap, L M; Sengupta, P S; Wilkinson, P M; Welch, R S; Swindell, R; Shanks, J H; Wilson, G; Slade, R J; Reynolds, K; Jayson, G C (2003). "Carcinosarcoma of the ovary". British Journal of Cancer. 88 (5): 654–657. doi:10.1038/sj.bjc.6600770. ISSN 0007-0920.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
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