Ovarian germ cell tumor differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Ovarian germ cell tumor}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Ovarian_germ_cell_tumor]]


{{CMG}}{{AE}} {{MD}}
{{CMG}}{{AE}} {{Sahar}} {{MD}}
==Overview==
==Overview==
Ovarian germ cell tumor must be differentiated from other ovarian mass.<ref name= sba>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</ref><ref name= ajk>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</ref>
[[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 From Ovarian Germ Cell Tumor Other Diseases==
==Differentiating Ovarian Germ Cell Tumor From Other Diseases==


* Stein-Leventhal syndrome<ref name= sba>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</ref><ref name= ajk>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</ref>
[[Ovarian]] [[germ cell]] [[tumor]] must be differentiated from other [[diseases]] that cause [[ovarian mass]], such as:<ref name= sba>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</ref><ref name= ajk>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</ref>
* Stein-Leventhal syndrome<ref name= sba>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</ref><ref name= ajk>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</ref><ref name="pmid22669919">{{cite journal |vauthors=Rozenholc A, Abdulcadir J, Pelte MF, Petignat P |title=A pelvic mass on ultrasonography and high human chorionic gonadotropin level: not always an ectopic pregnancy |journal=BMJ Case Rep |volume=2012 |issue= |pages= |date=June 2012 |pmid=22669919 |doi=10.1136/bcr.01.2012.5577 |url=}}</ref>
* 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]].<ref name="pmid22669919">{{cite journal |vauthors=Rozenholc A, Abdulcadir J, Pelte MF, Petignat P |title=A pelvic mass on ultrasonography and high human chorionic gonadotropin level: not always an ectopic pregnancy |journal=BMJ Case Rep |volume=2012 |issue= |pages= |date=June 2012 |pmid=22669919 |doi=10.1136/bcr.01.2012.5577 |url=}}</ref>
===Differentiating ovarian germ cell tumors from other diseases on the basis of age of onset, vaginal discharge, and constitutional symptoms===
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" rowspan="4" |Diseases
| colspan="6" |'''Clinical manifestations'''
! colspan="4" rowspan="2" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Age of onset'''
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunohistopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |pelvic/abdominal pain or pressure
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |vaginal bleeding/discharge
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |GI dysturbance
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Fever'''
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan/US
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI
|-
! colspan="14" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Gynecologic
|-
| rowspan="15" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovary|Ovarian]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Embryonal carcinoma]]<ref name="pmid6093440">{{cite journal| author=Krag Jacobsen G, Barlebo H, Olsen J, Schultz HP, Starklint H, Søgaard H et al.| title=Testicular germ cell tumours in Denmark 1976-1980. Pathology of 1058 consecutive cases. | journal=Acta Radiol Oncol | year= 1984 | volume= 23 | issue= 4 | pages= 239-47 | pmid=6093440 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6093440  }} </ref><ref name="IshidaHasegawa2008">{{cite journal|last1=Ishida|first1=M.|last2=Hasegawa|first2=M.|last3=Kanao|first3=K.|last4=Oyama|first4=M.|last5=Nakajima|first5=Y.|title=Non-palpable Testicular Embryonal Carcinoma Diagnosed by Ultrasound: A Case Report|journal=Japanese Journal of Clinical Oncology|volume=39|issue=2|year=2008|pages=124–126|issn=0368-2811|doi=10.1093/jjco/hyn141}}</ref><ref name="SteinWasnik2017">{{cite journal|last1=Stein|first1=Erica B.|last2=Wasnik|first2=Ashish P.|last3=Sciallis|first3=Andrew P.|last4=Kamaya|first4=Aya|last5=Maturen|first5=Katherine E.|title=MR Imaging–Pathologic Correlation in Ovarian Cancer|journal=Magnetic Resonance Imaging Clinics of North America|volume=25|issue=3|year=2017|pages=545–562|issn=10649689|doi=10.1016/j.mric.2017.03.004}}</ref><ref name="PectasidesPectasides2008">{{cite journal|last1=Pectasides|first1=D.|last2=Pectasides|first2=E.|last3=Kassanos|first3=D.|title=Germ cell tumors of the ovary|journal=Cancer Treatment Reviews|volume=34|issue=5|year=2008|pages=427–441|issn=03057372|doi=10.1016/j.ctrv.2008.02.002}}</ref><ref name="CaoGuo2009">{{cite journal|last1=Cao|first1=Dengfeng|last2=Guo|first2=Shuangping|last3=Allan|first3=Robert W.|last4=Molberg|first4=Kyle H.|last5=Peng|first5=Yan|title=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|journal=The American Journal of Surgical Pathology|volume=33|issue=6|year=2009|pages=894–904|issn=0147-5185|doi=10.1097/PAS.0b013e318198177d}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Individuals of any age, especially young adults
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
| style="background: #F5F5F5; padding: 5px;" |
* Elevated concentration of [[AFP|alfa-fetoprotein]] [[AFP|(AFP)]]
| style="background: #F5F5F5; padding: 5px;" |
* Decreased [[echogenicity]] on the [[ultrasound]] imaging
| style="background: #F5F5F5; padding: 5px;" |
* The [[tumor]] is large, predominantly [[solid]] and unilateral with areas of [[necrosis]] and [[hemorrhage]].
* There may be [[cystic]] areas that contains [[Mucus|mucoid]] material.
| style="background: #F5F5F5; padding: 5px;" |
* [[AFP]]
* [[Cytokeratin]] (AE1/AE3)
* Placental-like [[alkaline phosphatase]] in 50% of the individuals.
* SALL4 ([[nuclear]]) in > 90% of the cases.
* GPC3
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Tumor]] is usually a component of [[ovarian]] mixed [[germ cell]] [[tumors]].
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Gonadoblastoma]]<br><ref name="pmid4193741">{{cite journal| author=Scully RE| title=Gonadoblastoma. A review of 74 cases. | journal=Cancer | year= 1970 | volume= 25 | issue= 6 | pages= 1340-56 | pmid=4193741 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4193741  }} </ref><ref name="978-0-323-40067-1">{{cite book | last = Saia | first = Philip | title = Clinical gynecologic oncology | publisher = Elsevier | location = Philadelphia, PA | year = 2018 | isbn = 978-0-323-40067-1 }}</ref><ref name="EsinBaser2011">{{cite journal|last1=Esin|first1=Sertac|last2=Baser|first2=Eralp|last3=Kucukozkan|first3=Tuncay|last4=Magden|first4=Hasim Ata|title=Ovarian gonadoblastoma with dysgerminoma in a 15-year-old girl with 46, XX karyotype: case report and review of the literature|journal=Archives of Gynecology and Obstetrics|volume=285|issue=2|year=2011|pages=447–451|issn=0932-0067|doi=10.1007/s00404-011-2073-9}}</ref><ref name="LuisiriVogler1991">{{cite journal|last1=Luisiri|first1=A|last2=Vogler|first2=C|last3=Steinhardt|first3=G|last4=Silberstein|first4=M|title=Neonatal cystic testicular gonadoblastoma. Sonographic and pathologic findings.|journal=Journal of Ultrasound in Medicine|volume=10|issue=1|year=1991|pages=59–61|issn=02784297|doi=10.7863/jum.1991.10.1.59}}</ref><ref name="pmid10226831">{{cite journal |vauthors=Hatano T, Yoshino Y, Kawashima Y, Shirai H, Iizuka N, Miyazawa Y, Sakata A, Onishi T |title=Case of gonadoblastoma in a 9-year-old boy without physical abnormalities |journal=Int. J. Urol. |volume=6 |issue=3 |pages=164–6 |date=March 1999 |pmid=10226831 |doi= |url=}}</ref><ref name="CoolsStoop2006">{{cite journal|last1=Cools|first1=Martine|last2=Stoop|first2=Hans|last3=Kersemaekers|first3=Anne-Marie F.|last4=Drop|first4=Stenvert L. S.|last5=Wolffenbuttel|first5=Katja P.|last6=Bourguignon|first6=Jean-Pierre|last7=Slowikowska-Hilczer|first7=Jolanta|last8=Kula|first8=Krzysztof|last9=Faradz|first9=Sultana M. H.|last10=Oosterhuis|first10=J. Wolter|last11=Looijenga|first11=Leendert H. J.|title=Gonadoblastoma Arising in Undifferentiated Gonadal Tissue within Dysgenetic Gonads|journal=The Journal of Clinical Endocrinology & Metabolism|volume=91|issue=6|year=2006|pages=2404–2413|issn=0021-972X|doi=10.1210/jc.2005-2554}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Individuals of any age,but more common prior to 15 years of age
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
| style="background: #F5F5F5; padding: 5px;" |
* Elevated concentration of [[human chorionic gonadotropin]] (hCG), in case of coexisting [[dysgerminoma]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Solid]] [[mass]] with focal or extensive [[calcification]]<nowiki/>s with or without [[ascites]]
* [[Mass]] can be complex and have a [[cystic]] component
* Increased [[echogenicity]] on the [[ultrasound]] imaging
| style="background: #F5F5F5; padding: 5px;" |
* [[Solid]] [[mass]] with focal or extensive [[Calcification|calcifications]] with or withous [[ascites]]
* [[Mass]] can be complex and have a [[cystic]] component
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Tumor]] is [[Bilateral|bilatera]]<nowiki/>l in 50% of cases
* Focal [[calcification]] can be present in 80% of individuals
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovarian cyst|Follicular cysts]]<br><ref name="pmid20505067">{{cite journal |vauthors=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 |title=Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement |journal=Radiology |volume=256 |issue=3 |pages=943–54 |date=September 2010 |pmid=20505067 |doi=10.1148/radiol.10100213 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Women]] in [[Reproductive system|reproductive]] age (15 -45 y/o)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[estrogen]] +/–
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see a >3 cm simple [[cyst]] with no internal echo and with posterior acoustic enhancement
| style="background: #F5F5F5; padding: 5px;" |
* simple [[cyst]] with no internal echo or septa
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History]]/<br>[[imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[hyperestrogenism]] and [[endometrial hyperplasia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovarian cyst|Theca lutein cysts]]<br><ref name="pmid2455880">{{cite journal |vauthors=Montz FJ, Schlaerth JB, Morrow CP |title=The natural history of theca lutein cysts |journal=Obstet Gynecol |volume=72 |issue=2 |pages=247–51 |date=August 1988 |pmid=2455880 |doi= |url=}}</ref><ref name="Southam1962">{{cite journal|last1=Southam|first1=Anna L.|title=Massive Ovarian Hyperstimulation with Clomiphene Citrate|journal=JAMA: The Journal of the American Medical Association|volume=181|issue=5|year=1962|pages=443|issn=0098-7484|doi=10.1001/jama.1962.03050310083018b}}</ref><ref name="NguyenReid1986">{{cite journal|last1=Nguyen|first1=K T|last2=Reid|first2=R L|last3=Sauerbrei|first3=E|title=Antenatal sonographic detection of a fetal theca lutein cyst: a clue to maternal diabetes mellitus.|journal=Journal of Ultrasound in Medicine|volume=5|issue=11|year=1986|pages=665–667|issn=02784297|doi=10.7863/jum.1986.5.11.665}}</ref>
 
| style="background: #F5F5F5; padding: 5px;" |
* [[Women]] in [[reproductive]] age (15 -45 y/o)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* Depends on the underlying [[etiology]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see bilaterally enlarged [[ovaries]] with multiple [[cysts]]
| style="background: #F5F5F5; padding: 5px;" |
* Multiple bilateral [[cysts]]
| style="background: #F5F5F5; padding: 5px;" |
* Theca interna cell [[Hyperplasia]]
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History]]/<br>[[imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[Hydatidiform mole|hydatidiform moles]], [[choriocarcinoma]], [[diabetes mellitus]] and [[clomiphene]] intake ([[ovulation]] induction)
|-
| 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: #F5F5F5; padding: 5px;" |
* >55 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* Elevated levels of [[CA-125|serum cancer antigen-125]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|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]]
| style="background: #F5F5F5; padding: 5px;" |
* 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
| style="background: #F5F5F5; padding: 5px;" |
* [[Cyst]] wall consist of [[benign]]/[[malignant]] [[Fallopian tube|Fallopian]] [[Epithelium|epithelial]] layer
 
* [[Psammoma body]]
* In serous cystadenocarcinoma we may see [[papillary]] projection inside the [[cyst]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Most common [[ovarian neoplasm]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mucinous cystadenoma]]/carcinoma<br><ref name="pmid9850171">{{cite journal |vauthors=Hoerl HD, Hart WR |title=Primary ovarian mucinous cystadenocarcinomas: a clinicopathologic study of 49 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=22 |issue=12 |pages=1449–62 |date=December 1998 |pmid=9850171 |doi= |url=}}</ref><ref name="pmid11075847">{{cite journal |vauthors=Lee KR, Scully RE |title=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' |journal=Am. J. Surg. Pathol. |volume=24 |issue=11 |pages=1447–64 |date=November 2000 |pmid=11075847 |doi= |url=}}</ref><ref name="JungLee2002">{{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>
| style="background: #F5F5F5; padding: 5px;" |
* >55 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* Elevated levels of [[CA-125|serum cancer antigen-125]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see large simple [[cyst]] with septation
* In [[mucinous cystadenocarcinoma]] we may see thickened internal septation with solid components inside the [[Cyst of urachus|cyst]]
| style="background: #F5F5F5; padding: 5px;" |
* 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
| style="background: #F5F5F5; padding: 5px;" |
* [[Cyst]] wall consist of [[Columnar epithelia|columnar]] [[Endocervix|endocervical]] [[epithelium]]
* We may see gelatinous [[mucin]] inside the [[cyst]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It may cause [[pseudomyxoma peritonei]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrioma]]<br><ref name="pmid9848302">{{cite journal |vauthors=Mol BW, Bayram N, Lijmer JG, Wiegerinck MA, Bongers MY, van der Veen F, Bossuyt PM |title=The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis |journal=Fertil. Steril. |volume=70 |issue=6 |pages=1101–8 |date=December 1998 |pmid=9848302 |doi= |url=}}</ref><ref name="KinkelFrei2005">{{cite journal|last1=Kinkel|first1=Karen|last2=Frei|first2=Kathrin A.|last3=Balleyguier|first3=Corinne|last4=Chapron|first4=Charles|title=Diagnosis of endometriosis with imaging: a review|journal=European Radiology|volume=16|issue=2|year=2005|pages=285–298|issn=0938-7994|doi=10.1007/s00330-005-2882-y}}</ref><ref name="de ZieglerBorghese2010">{{cite journal|last1=de Ziegler|first1=Dominique|last2=Borghese|first2=Bruno|last3=Chapron|first3=Charles|title=Endometriosis and infertility: pathophysiology and management|journal=The Lancet|volume=376|issue=9742|year=2010|pages=730–738|issn=01406736|doi=10.1016/S0140-6736(10)60490-4}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Women's College Hospital|Women]] in [[reproductive]] age (15 -45 y/o)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Iron deficiency anemia]] 
 
* Elevated levels of [[CA-125|serum cancer antigen-125]]
* Increased levels of [[interleukin 1]], [[chemoattractant]] protein-1, and [[Interferon-gamma|interferon gamma]]
| style="background: #F5F5F5; padding: 5px;" |
* Complex [[mass]] on [[Ultrasound|US]]
* Increased [[Doppler ultrasound|Doppler]] flow because of increased vascularture
* It may present with [[catamenial pneumothorax]], [[hemothorax]], and [[lung]] [[nodules]] in [[CT scan]].
| style="background: #F5F5F5; padding: 5px;" |
* hyperintensity on T1-weighted images and a hypointensity on T2-weighted [[images]]
* Powder burn [[hemorrhages]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Chocolate cyst]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Laparoscopy]]
| style="background: #F5F5F5; padding: 5px;" |
* It may cause [[infertility]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Teratoma]]<br><ref name="KawaiKano1992">{{cite journal|last1=Kawai|first1=Michiyasu|last2=Kano|first2=Takeo|last3=Kikkawa|first3=Fumitaka|last4=Morikawa|first4=Yoshimitsu|last5=Oguchi|first5=Hidenori|last6=Nakashima|first6=Nobuo|last7=Ishizuka|first7=Takao|last8=Kuzuya|first8=Kazuo|last9=Ohta|first9=Masahiro|last10=Arii|first10=Yoshitaro|last11=Tomoda|first11=Yutaka|title=Seven tumor markers in benign and malignant germ cell tumors of the ovary|journal=Gynecologic Oncology|volume=45|issue=3|year=1992|pages=248–253|issn=00908258|doi=10.1016/0090-8258(92)90299-X}}</ref><ref name="DunzendorferdeLAS MORENAS1999">{{cite journal|last1=Dunzendorfer|first1=Thomas|last2=deLAS MORENAS|first2=ANTONIO|last3=Kalir|first3=Tamara|last4=Levin|first4=Robert M.|title=Struma Ovarii and Hyperthyroidism|journal=Thyroid|volume=9|issue=5|year=1999|pages=499–502|issn=1050-7256|doi=10.1089/thy.1999.9.499}}</ref><ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref><ref name="SabaGuerriero2009">{{cite journal|last1=Saba|first1=Luca|last2=Guerriero|first2=Stefano|last3=Sulcis|first3=Rosa|last4=Virgilio|first4=Bruna|last5=Melis|first5=GianBenedetto|last6=Mallarini|first6=Giorgio|title=Mature and immature ovarian teratomas: CT, US and MR imaging characteristics|journal=European Journal of Radiology|volume=72|issue=3|year=2009|pages=454–463|issn=0720048X|doi=10.1016/j.ejrad.2008.07.044}}</ref>
 
| style="background: #F5F5F5; padding: 5px;" |
* 10-30 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[HCG]] and [[LDH]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see [[cystic]] [[adnexal]] [[mass]] with mural components and echogenic [[lesion]] due to [[calcification]]
* The iceberg [[sign]]
* Dot-dash pattern
| style="background: #F5F5F5; padding: 5px;" |
* We may see evidence of [[fat]] components
| style="background: #F5F5F5; padding: 5px;" |
* All three [[Germ layer|germ layers]] [[Cell (biology)|cell]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* 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]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Dysgerminoma]]<br><ref name="DganiShoham(Schwartz)1988">{{cite journal|last1=Dgani|first1=R.|last2=Shoham(Schwartz)|first2=Z.|last3=Czernobilsky|first3=B.|last4=Kaftori|first4=A.|last5=Borenstein|first5=R.|last6=Lancet|first6=M.|title=Lactic dehydrogenase, alkaline phosphatase and human chorionic gonadotropin in a pure ovarian dysgerminoma|journal=Gynecologic Oncology|volume=30|issue=1|year=1988|pages=44–50|issn=00908258|doi=10.1016/0090-8258(88)90044-3}}</ref><ref name="pmid8188914">{{cite journal |vauthors=Tanaka YO, Kurosaki Y, Nishida M, Michishita N, Kuramoto K, Itai Y, Kubo T |title=Ovarian dysgerminoma: MR and CT appearance |journal=J Comput Assist Tomogr |volume=18 |issue=3 |pages=443–8 |date=1994 |pmid=8188914 |doi= |url=}}</ref>
 
| style="background: #F5F5F5; padding: 5px;" |
* in the second to third decade of life
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[HCG]] and [[LDH]]
* [[Hypercalcemia]]
| style="background: #F5F5F5; padding: 5px;" |
* Multilobulated solid [[Mass|masses]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see [[ovarian]] [[mass]] with septation which are hyperintense on T1 and hypo or isointense on T2 [[imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* Sheets fried egg appearance [[Cell (biology)|cells]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Same as [[male]] [[seminoma]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Yolk sac tumor]]<br><ref name="Yang2000">{{cite journal|last1=Yang|first1=Grace C.H.|title=Fine-needle aspiration cytology of Schiller-Duval bodies of yolk-sac tumor|journal=Diagnostic Cytopathology|volume=23|issue=4|year=2000|pages=228–232|issn=8755-1039|doi=10.1002/1097-0339(200010)23:4<228::AID-DC2>3.0.CO;2-M}}</ref><ref name="LevitinHaller1996">{{cite journal|last1=Levitin|first1=A|last2=Haller|first2=K D|last3=Cohen|first3=H L|last4=Zinn|first4=D L|last5=O'Connor|first5=M T|title=Endodermal sinus tumor of the ovary: imaging evaluation.|journal=American Journal of Roentgenology|volume=167|issue=3|year=1996|pages=791–793|issn=0361-803X|doi=10.2214/ajr.167.3.8751702}}</ref><ref name="TalermanHaije1974">{{cite journal|last1=Talerman|first1=A.|last2=Haije|first2=W. G.|title=Alpha-fetoprotein and germ cell tumors: A possible role of yolk sac tumor in production of alpha-fetoprotein|journal=Cancer|volume=34|issue=5|year=1974|pages=1722–1726|issn=0008-543X|doi=10.1002/1097-0142(197411)34:5<1722::AID-CNCR2820340521>3.0.CO;2-F}}</ref>
 
| style="background: #F5F5F5; padding: 5px;" |
* Young [[children]]
* [[Male]] [[infants]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* High levels of [[AFP]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see a combination of echogenic and hypoechoic components
| style="background: #F5F5F5; padding: 5px;" |
* [[Ovarian mass]] with [[hemorrhagic]] areas
| style="background: #F5F5F5; padding: 5px;" |
* Yellow appearance
 
* [[Hemorrhagic]]
 
* Schiller-Duval bodies ([[glomeruli]] like structures)
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* The other name is [[Ovarian cyst|ovarian]] [[endodermal sinus tumor]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fibroma]]<br><ref name="pmid13148256">{{cite journal |vauthors=MEIGS JV |title=Fibroma of the ovary with ascites and hydrothorax; Meigs' syndrome |journal=Am. J. Obstet. Gynecol. |volume=67 |issue=5 |pages=962–85 |date=May 1954 |pmid=13148256 |doi= |url=}}</ref><ref name="SivanesaratnamDutta1990">{{cite journal|last1=Sivanesaratnam|first1=V.|last2=Dutta|first2=R.|last3=Jayalakshmi|first3=P.|title=Ovarian fibroma - clinical and histopathological characteristics|journal=International Journal of Gynecology & Obstetrics|volume=33|issue=3|year=1990|pages=243–247|issn=00207292|doi=10.1016/0020-7292(90)90009-A}}</ref><ref name="AbadCazorla1999">{{cite journal|last1=Abad|first1=Antonio|last2=Cazorla|first2=Eduardo|last3=Ruiz|first3=Fernando|last4=Aznar|first4=Ismael|last5=Asins|first5=Enrique|last6=Llixiona|first6=Joaquin|title=Meigs' syndrome with elevated CA125: case report and review of the literature|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=82|issue=1|year=1999|pages=97–99|issn=03012115|doi=10.1016/S0301-2115(98)00174-2}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >50 y/o
| style="background: #F5F5F5; padding: 5px;" |
* Pulling sensation in the [[groin]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* High levels of [[CA-125]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see a unilateral [[mass]] with poor contrast enhancement
| style="background: #F5F5F5; padding: 5px;" |
* Low signal intensity on T1 and T2
 
* We may see scattered hyperintense areas due to  [[edema]] or [[cystic]] [[degeneration]]
| style="background: #F5F5F5; padding: 5px;" |
* Spindle-shaped [[fibroblast]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It may cause [[Meigs syndrome]] ([[ovarian fibroma]], [[ascites]], and [[hydrothorax]])
* It may cause [[ovarian torsion]]
* It may cause [[pleural effusion]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thecoma]]<br><ref name="YaghoobianPinck1983">{{cite journal|last1=Yaghoobian|first1=Jahanguir|last2=Pinck|first2=Robert L.|title=Ultrasound findings in thecoma of the ovary|journal=Journal of Clinical Ultrasound|volume=11|issue=2|year=1983|pages=91–93|issn=00912751|doi=10.1002/jcu.1870110207}}</ref><ref name="LiZhang2012">{{cite journal|last1=Li|first1=Xinchun|last2=Zhang|first2=Weidong|last3=Zhu|first3=Guangbin|last4=Sun|first4=Congpeng|last5=Liu|first5=Qingyu|last6=Shen|first6=Yuechun|title=Imaging Features and Pathologic Characteristics of Ovarian Thecoma|journal=Journal of Computer Assisted Tomography|volume=36|issue=1|year=2012|pages=46–53|issn=0363-8715|doi=10.1097/RCT.0b013e31823f6186}}</ref><ref name="ProctorGreeley1951">{{cite journal|last1=Proctor|first1=Francis E.|last2=Greeley|first2=Joseph P.|last3=Rathmell|first3=Thomas K.|title=Malignant thecoma of the ovary|journal=American Journal of Obstetrics and Gynecology|volume=62|issue=1|year=1951|pages=185–192|issn=00029378|doi=10.1016/0002-9378(51)91109-X}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >50 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* [[Postmenopausal bleeding]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[estrogen]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see non-specific [[ovarian]] [[mass]]
 
* We may see evidence of [[endometrial hyperplasia]] due to increased level of [[estrogen]]
| style="background: #F5F5F5; padding: 5px;" |
* Hyperintense on T2
* T1 intensity depends on the amount of [[fibrous tissue]] ([[fibrous tissue]] lead to hypointensity)
| style="background: #F5F5F5; padding: 5px;" |
* Lipid-laden [[Stromal cell|stromal cells]] with pale, vaculolated [[cytoplasm]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see [[endometrial cancer]] as e result of hyper-[[Estrogen|estrogenism]]
* We may see [[ovarian]] fibrothecoma (mixture of [[fibroma]] and [[thecoma]])
 
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Granulosa cell tumour|Granulosa cell tumor]]<br><ref name="pmid17945423">{{cite journal |vauthors=Pectasides D, Pectasides E, Psyrri A |title=Granulosa cell tumor of the ovary |journal=Cancer Treat. Rev. |volume=34 |issue=1 |pages=1–12 |date=February 2008 |pmid=17945423 |doi=10.1016/j.ctrv.2007.08.007 |url=}}</ref><ref name="StenwigHazekamp1979">{{cite journal|last1=Stenwig|first1=Jan Trygve|last2=Hazekamp|first2=Johan The.|last3=Beecham|first3=Jackson B.|title=Granulosa cell tumors of the ovary. A clinicopathological study of 118 cases with long-term follow-up|journal=Gynecologic Oncology|volume=7|issue=2|year=1979|pages=136–152|issn=00908258|doi=10.1016/0090-8258(79)90090-8}}</ref><ref name="pmid9386298">{{cite journal |vauthors=Morikawa K, Hatabu H, Togashi K, Kataoka ML, Mori T, Konishi J |title=Granulosa cell tumor of the ovary: MR findings |journal=J Comput Assist Tomogr |volume=21 |issue=6 |pages=1001–4 |date=1997 |pmid=9386298 |doi= |url=}}</ref><ref name="pmid10227493">{{cite journal |vauthors=Ko SF, Wan YL, Ng SH, Lee TY, Lin JW, Chen WJ, Kung FT, Tsai CC |title=Adult ovarian granulosa cell tumors: spectrum of sonographic and CT findings with pathologic correlation |journal=AJR Am J Roentgenol |volume=172 |issue=5 |pages=1227–33 |date=May 1999 |pmid=10227493 |doi=10.2214/ajr.172.5.10227493 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* 50-60 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Postmenopausal bleeding]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[estrogen]] and [[Progesterone|progesteron]]
* We may see [[inhibin]], [[calretinin]], and [[Ki-67]] on the surface of [[Granulosa cell|granulosa]] [[tumor]] [[Cell (biology)|cells]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see solid, [[cystic]], or multiloculated solid and [[cystic]] [[mass]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see solid, [[Cystic Cytoplasm|cystic]], or multiloculated solid and [[cystic]] [[mass]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Call-Exner bodies]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[postmenopausal]] [[women]] may cause [[breast]] [[tenderness]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sertoli-Leydig cell tumor|Sertoli-leydig cell tumor]]<br><ref name="LantzschStoerer2001">{{cite journal|last1=Lantzsch|first1=T.|last2=Stoerer|first2=S.|last3=Lawrenz|first3=K.|last4=Buchmann|first4=J.|last5=Strauss|first5=H.-G.|last6=Koelbl|first6=H.|title=Sertoli-Leydig cell tumor|journal=Archives of Gynecology and Obstetrics|volume=264|issue=4|year=2001|pages=206–208|issn=0932-0067|doi=10.1007/s004040000114}}</ref><ref name="JungRha2005">{{cite journal|last1=Jung|first1=Seung Eun|last2=Rha|first2=Sung Eun|last3=Lee|first3=Jae Mun|last4=Park|first4=Soo Youn|last5=Oh|first5=Soon Nam|last6=Cho|first6=Kyoung Sik|last7=Lee|first7=Eun Ju|last8=Byun|first8=Jae Young|last9=Hahn|first9=Seong Tai|title=CT and MRI Findings of Sex Cord–Stromal Tumor of the Ovary|journal=American Journal of Roentgenology|volume=185|issue=1|year=2005|pages=207–215|issn=0361-803X|doi=10.2214/ajr.185.1.01850207}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* 15 to 35 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* Elevated [[serum]] [[testosterone]] level
* Elevated [[alpha-fetoprotein]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see unilateral Well-defined hypoechoic [[lesion]]
 
| style="background: #F5F5F5; padding: 5px;" |
* Low T2 signal intensity
* areas of high signal intensity
| style="background: #F5F5F5; padding: 5px;" |
* Lydig [[Cell (biology)|cells]] (Polygonal pink [[Cell (biology)|cells]] with [[eosinophilic]] [[cytoplasm]]
 
* [[Sertoli cell|Sertoli cells]] (clear vacuolated [[cytoplasm]])
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It may cause [[virilization]] [[Symptom|symptoms]] and [[amenorrhea]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brenner tumor]]<br><ref name="ShevchukFenoglio1980">{{cite journal|last1=Shevchuk|first1=Maria M.|last2=Fenoglio|first2=Cecilia M.|last3=Richart|first3=Ralph M.|title=Histogenesis of brenner tumors, I: Histology and ultrastructure|journal=Cancer|volume=46|issue=12|year=1980|pages=2607–2616|issn=0008-543X|doi=10.1002/1097-0142(19801215)46:12<2607::AID-CNCR2820461213>3.0.CO;2-Q}}</ref><ref name="OutwaterSiegelman1998">{{cite journal|last1=Outwater|first1=Eric K|last2=Siegelman|first2=Evan S|last3=Kim|first3=Bohyun|last4=Chiowanich|first4=Peerapod|last5=Blasbalg|first5=Roberto|last6=Kilger|first6=Alex|title=Ovarian Brenner tumors: MR imaging characteristics|journal=Magnetic Resonance Imaging|volume=16|issue=10|year=1998|pages=1147–1153|issn=0730725X|doi=10.1016/S0730-725X(98)00136-2}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >55 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
:* In [[Ultrasound|US]] we may see hypoechoic solid [[Mass-to-charge ratio|mass]] and [[calcification]]
| style="background: #F5F5F5; padding: 5px;" |
* Hypointense on T2 because of [[fibrous]] content
| style="background: #F5F5F5; padding: 5px;" |
* Yellow/pale appearance
* [[Transitional cell]] [[tumor]] (resembles [[Urinary bladder|bladder]])
* Coffee bean [[nuclei]] on [[H&E stain|H&E]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* Most of the times it's an accidental finding
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Krukenberg tumor|Krukenberg tumor]]<br><ref name="pmid8626898">{{cite journal |vauthors=Kim SH, Kim WH, Park KJ, Lee JK, Kim JS |title=CT and MR findings of Krukenberg tumors: comparison with primary ovarian tumors |journal=J Comput Assist Tomogr |volume=20 |issue=3 |pages=393–8 |date=1996 |pmid=8626898 |doi= |url=}}</ref><ref name="pmid17076540">{{cite journal |vauthors=Al-Agha OM, Nicastri AD |title=An in-depth look at Krukenberg tumor: an overview |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=11 |pages=1725–30 |date=November 2006 |pmid=17076540 |doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >55 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
Based on underlying [[malignancy]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* In case of [[Metastasis|metastatic]] [[Gastrointestinal cancer|GI cancers]] we may see [[iron deficiency anemia]]
| style="background: #F5F5F5; padding: 5px;" |
* Mostly bilateral, complex ovarian [[lesion]]
* In [[CT scan]] we may see evidence of concurrent [[malignancy]] in other [[organs]]
| style="background: #F5F5F5; padding: 5px;" |
* Mostly bilateral, complex [[Ovary|ovarian]] [[lesion]] with solid components
* Internal hyperintensity on T1 and T2 weighted [[Mri|MR]] [[images]] because of [[Mucin 17|mucin]]
* Evidence of concurrent [[malignancy]] in other [[organs]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Mucin]]-secreting [[signet cell]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]/<br>[[biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* The most common [[primary tumor]] is in [[Colon (anatomy)|colon]], [[stomach]], [[breast]], [[lung]], and contralateral [[ovary]]
* Based on underlying [[malignancy]] it may cause [[pleural effusion]]
|-
| rowspan="5" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fallopian tube|Tubal]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[tubo-ovarian abscess]]<br><ref name="LandersSweet1983">{{cite journal|last1=Landers|first1=D. V.|last2=Sweet|first2=R. L.|title=Tubo-ovarian Abscess: Contemporary Approach to Management|journal=Clinical Infectious Diseases|volume=5|issue=5|year=1983|pages=876–884|issn=1058-4838|doi=10.1093/clinids/5.5.876}}</ref><ref name="Stewart TaylorMcMillan1975">{{cite journal|last1=Stewart Taylor|first1=E.|last2=McMillan|first2=James H.|last3=Greer|first3=Benjamin E.|last4=Droegemueller|first4=William|last5=Thompson|first5=Horace E.|title=The intrauterine device and tubo-ovarian abscess|journal=American Journal of Obstetrics and Gynecology|volume=123|issue=4|year=1975|pages=338–348|issn=00029378|doi=10.1016/S0002-9378(16)33434-2}}</ref><ref name="HaLim1995">{{cite journal|last1=Ha|first1=H. K.|last2=Lim|first2=G. Y.|last3=Cha|first3=E. S.|last4=Lee|first4=H. G.|last5=Ro|first5=H. J.|last6=Kim|first6=H. S.|last7=Kim|first7=H. H.|last8=Joo|first8=S. W.|last9=Jee|first9=M. K.|title=MR Imaging of Tubo-Ovarian Abscess|journal=Acta Radiologica|volume=36|issue=5|year=1995|pages=510–514|issn=0284-1851|doi=10.1080/02841859509173418}}</ref><ref name="pmid12854857">{{cite journal |vauthors=Varras M, Polyzos D, Perouli E, Noti P, Pantazis I, Akrivis Ch |title=Tubo-ovarian abscesses: spectrum of sonographic findings with surgical and pathological correlations |journal=Clin Exp Obstet Gynecol |volume=30 |issue=2-3 |pages=117–21 |date=2003 |pmid=12854857 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* Young [[women]] (15-30 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* High levels of [[Inflammation|inflammatory]] [[Marker|markers]]
* [[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see multilocular complex [[lesion]] mostly [[bilateral]] with debry inside
| style="background: #F5F5F5; padding: 5px;" |
* We may see a [[Pelvic masses|pelvic mass]] filled with [[fluid]] with thick walls
 
* hypointense in T1 and  heterogeneous in T2
| style="background: #F5F5F5; padding: 5px;" |
* In [[abscess]] [[aspiration]] we may see [[Anaerobic organism|anaerobic organisms]]
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History]]/<br>[[imaging]]
| style="background: #F5F5F5; padding: 5px;" |
*The most common [[Risk factor|risk factors]] are previous [[PID]], [[diabetes mellitus]], [[intrauterine device]] and [[History and Physical examination|history]] of [[Uterus|uterine]] [[surgery]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ectopic pregnancy]]<br><ref name="Barnhart2009">{{cite journal|last1=Barnhart|first1=Kurt T.|title=Ectopic Pregnancy|journal=New England Journal of Medicine|volume=361|issue=4|year=2009|pages=379–387|issn=0028-4793|doi=10.1056/NEJMcp0810384}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Women]] in [[reproductive]] age (15 -45 y/o)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[HCG|BhCG]]
* [[Progesterone]] level ≤5 ng/ml
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see empty [[uterine cavity]], [[Fallopian tube|tubal]] ring sign, ring of fire sign ([[Doppler]]), extra-[[uterine]] [[Fetus|fetal]] [[heart rate]]
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History]]/<br>[[imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* Any [[women]] in [[reproductive]] age presenting with [[abdominal pain]] or  [[amenorrhea]] should be screened for [[ectopic pregnancy]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrosalpinx]]<br><ref name="KimRha2009">{{cite journal|last1=Kim|first1=Mi Young|last2=Rha|first2=Sung Eun|last3=Oh|first3=Soon Nam|last4=Jung|first4=Seung Eun|last5=Lee|first5=Young Joon|last6=Kim|first6=You Sung|last7=Byun|first7=Jae Young|last8=Lee|first8=Ahwon|last9=Kim|first9=Mee-Ran|title=MR Imaging Findings of Hydrosalpinx: A Comprehensive Review|journal=RadioGraphics|volume=29|issue=2|year=2009|pages=495–507|issn=0271-5333|doi=10.1148/rg.292085070}}</ref><ref name="pmid7938766">{{cite journal |vauthors=Atri M, Nazarnia S, Bret PM, Aldis AE, Kintzen G, Reinhold C |title=Endovaginal sonographic appearance of benign ovarian masses |journal=Radiographics |volume=14 |issue=4 |pages=747–60; discussion 761–2 |date=July 1994 |pmid=7938766 |doi=10.1148/radiographics.14.4.7938766 |url=}}</ref><ref name="ChanellesDucarme2011">{{cite journal|last1=Chanelles|first1=Olivier|last2=Ducarme|first2=Guillaume|last3=Sifer|first3=Christophe|last4=Hugues|first4=Jean-Noel|last5=Touboul|first5=Cyril|last6=Poncelet|first6=Christophe|title=Hydrosalpinx and infertility: what about conservative surgical management?|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=159|issue=1|year=2011|pages=122–126|issn=03012115|doi=10.1016/j.ejogrb.2011.07.004}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see [[Fallopian tube|tubal]] longitudinal folds thickening (cogwheel appearance)
* In [[CT scan]] we may see tubular [[Adnexa|adnexal]] [[lesion]] with [[fluid]] attenuation
| style="background: #F5F5F5; padding: 5px;" |
* Dilated [[Fallopian tube]] with [[fluid]] signal intensity
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[endometriosis]] (haematosalpinx), [[ovulation]] induction, [[pelvic inflammatory disease]], post-[[hysterectomy]], [[tubal ligation]], and tubal [[malignancy]]
 
* It may cause [[infertility]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Salpingitis]]<br><ref name="pmid7976247">{{cite journal |vauthors=Czerwenka K, Heuss F, Hosmann J, Manavi M, Jelincic D, Kubista E |title=Salpingitis caused by Chlamydia trachomatis and its significance for infertility |journal=Acta Obstet Gynecol Scand |volume=73 |issue=9 |pages=711–5 |date=October 1994 |pmid=7976247 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Women]] of [[reproductive]] age
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Leukocytosis (patient information)|Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see , [[Edema|edematous]] and thickened endosalpingeal folds
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History/<br>physical<br>exam]]
| style="background: #F5F5F5; padding: 5px;" |
* It may cause  [[infertility]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fallopian tube cancer|Fallopian tube carcinoma]]<br><ref name="NiloffKlug1984">{{cite journal|last1=Niloff|first1=Jonathan M.|last2=Klug|first2=Thomas L.|last3=Schaetzl|first3=Elena|last4=Zurawski|first4=Vincent R.|last5=Knapp|first5=Robert C.|last6=Bast|first6=Robert C.|title=Elevation of serum CA125 in carcinomas of the fallopian tube, endometrium, and endocervix|journal=American Journal of Obstetrics and Gynecology|volume=148|issue=8|year=1984|pages=1057–1058|issn=00029378|doi=10.1016/S0002-9378(84)90444-7}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >60 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* High levels of [[CA-125|CA125]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Ultrasound|US]] findings are non specific (complex [[Mass–energy equivalence|mass]] on [[Fallopian tube]]
 
* We may see [[papillary]] projections
| style="background: #F5F5F5; padding: 5px;" |
* 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
| style="background: #F5F5F5; padding: 5px;" |
* Based on the [[Tumor suppressor gene|tumor]] type we may have different [[biopsy]] finding
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see Latzko triad ([[abdominal pain]], [[Vagina|vaginal]] discgarge, [[Pelvic masses|pelvic mass]])
* It may cause [[Pleural effusion (patient information)|pleural effusion]]
|-
| rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Uterus|Uterine]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leiomyoma]]<br><ref name="BullettiDe Ziegler1999">{{cite journal|last1=Bulletti|first1=Carlo|last2=De Ziegler|first2=Dominique|last3=Polli|first3=Valeria|last4=Flamigni|first4=Carlo|title=The role of leiomyomas in infertility|journal=The Journal of the American Association of Gynecologic Laparoscopists|volume=6|issue=4|year=1999|pages=441–445|issn=10743804|doi=10.1016/S1074-3804(99)80008-5}}</ref><ref name="MuraseSiegelman1999">{{cite journal|last1=Murase|first1=Eiko|last2=Siegelman|first2=Evan S.|last3=Outwater|first3=Eric K.|last4=Perez-Jaffe|first4=Liza A.|last5=Tureck|first5=Richard W.|title=Uterine Leiomyomas: Histopathologic Features, MR Imaging Findings, Differential Diagnosis, and Treatment|journal=RadioGraphics|volume=19|issue=5|year=1999|pages=1179–1197|issn=0271-5333|doi=10.1148/radiographics.19.5.g99se131179}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Women]] of [[reproductive]] age
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* In [[chronic]] cases, we may see mild [[anemia]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|US]] we may see hypoechoic [[Mass-independent fractionation|mass]] with [[calcification]] and [[Cyst|cystic]] areas of [[necrosis]] or [[degeneration]] may
| style="background: #F5F5F5; padding: 5px;" |
* Low to intermediate signal intensity on T1 and T2
* In case of [[necrosis]] inside the [[mass]], there might be some high signal [[Lesion|lesions]] on T2
| style="background: #F5F5F5; padding: 5px;" |
* [[Smooth muscle]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* It may cause  [[infertility]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Choriocarcinoma]]<br><ref name="SecklFisher2000">{{cite journal|last1=Seckl|first1=Michael J|last2=Fisher|first2=Rosemary A|last3=Salerno|first3=Giovanni|last4=Rees|first4=Helene|last5=Paradinas|first5=Fernando J|last6=Foskett|first6=Marianne|last7=Newlands|first7=Edward S|title=Choriocarcinoma and partial hydatidiform moles|journal=The Lancet|volume=356|issue=9223|year=2000|pages=36–39|issn=01406736|doi=10.1016/S0140-6736(00)02432-6}}</ref><ref name="NishikawaKaseki1985">{{cite journal|last1=Nishikawa|first1=Yoshiki|last2=Kaseki|first2=Shigeaki|last3=Tomoda|first3=Yutaka|last4=Ishizuka|first4=Takao|last5=Asai|first5=Yasumasa|last6=Suzuki|first6=Toshio|last7=Ushijima|first7=Hiroshi|title=Histopathologic classification of uterine choriocarcinoma|journal=Cancer|volume=55|issue=5|year=1985|pages=1044–1051|issn=0008-543X|doi=10.1002/1097-0142(19850301)55:5<1044::AID-CNCR2820550520>3.0.CO;2-7}}</ref><ref name="pmid558566">{{cite journal |vauthors=Libshitz HI, Baber CE, Hammond CB |title=The pulmonary metastases of choriocarcinoma |journal=Obstet Gynecol |volume=49 |issue=4 |pages=412–6 |date=April 1977 |pmid=558566 |doi= |url=}}</ref><ref name="pmid16114202">{{cite journal |vauthors=Diouf A, Cissé ML, Laïco A, Ndiaye D, Moreau JC, Diadhiou F |title=[Sonographic features of gestational choriocarcinoma] |language=French |journal=J Radiol |volume=86 |issue=5 Pt 1 |pages=469–73 |date=May 2005 |pmid=16114202 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Women]] in [[reproductive]] age (15 -45 y/o)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[HCG|B-hCG]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|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
| style="background: #F5F5F5; padding: 5px;" |
* We may see an infiltrative [[Uterine Cancer|uterine]] mass and  thickening of [[Uterus|uterine]] wall
| style="background: #F5F5F5; padding: 5px;" |
* [[Trophoblast]]<nowiki/>ic [[tissue]] origin
* columns and sheets of [[trophoblast]]<nowiki/>ic tissue invading uterine [[Myotome|muscle]] and [[blood vessels]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with bilateral [[Ovarian cyst|theca lutein cysts]]
* Cannonball [[Metastasis|metastases]] to the [[lungs]]
* May cause [[hemoptysis]]
* We may see passing of grapes like tissue from the [[vagina]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leiomyosarcoma]]<br><ref name="SekiHoshihara1992">{{cite journal|last1=Seki|first1=K.|last2=Hoshihara|first2=T.|last3=Nagata|first3=I.|title=Leiomyosarcoma of the Uterus: Ultrasonography and Serum Lactate Dehydrogenase Level|journal=Gynecologic and Obstetric Investigation|volume=33|issue=2|year=1992|pages=114–118|issn=1423-002X|doi=10.1159/000294861}}</ref><ref name="pmid17009628">{{cite journal |vauthors=Juang CM, Yen MS, Horng HC, Twu NF, Yu HC, Hsu WL |title=Potential role of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma |journal=Eur. J. Gynaecol. Oncol. |volume=27 |issue=4 |pages=370–4 |date=2006 |pmid=17009628 |doi= |url=}}</ref><ref name="PattaniKier1995">{{cite journal|last1=Pattani|first1=Sita J.|last2=Kier|first2=Ruben|last3=Deal|first3=Robert|last4=Luchansky|first4=Edward|title=MRI of uterine leiomyosarcoma|journal=Magnetic Resonance Imaging|volume=13|issue=2|year=1995|pages=331–333|issn=0730725X|doi=10.1016/0730-725X(95)93813-5}}</ref><ref name="McLeodZornoza1984">{{cite journal|last1=McLeod|first1=A J|last2=Zornoza|first2=J|last3=Shirkhoda|first3=A|title=Leiomyosarcoma: computed tomographic findings.|journal=Radiology|volume=152|issue=1|year=1984|pages=133–136|issn=0033-8419|doi=10.1148/radiology.152.1.6729102}}</ref><ref name="RobboyBentley2000">{{cite journal|last1=Robboy|first1=Stanley J.|last2=Bentley|first2=Rex C.|last3=Butnor|first3=Kelly|last4=Anderson|first4=Malcolm C.|title=Pathology and Pathophysiology of Uterine Smooth-Muscle Tumors|journal=Environmental Health Perspectives|volume=108|year=2000|pages=779|issn=00916765|doi=10.2307/3454306}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >55 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* In some cases we may see elevated levels of [[CA-125]] [[lactate dehydrogenase]]
| style="background: #F5F5F5; padding: 5px;" |
* Heterogeneous mass with central low attenuation ([[necrosis]]) and  [[calcification]].
| style="background: #F5F5F5; padding: 5px;" |
* Increased [[uterine]] size
* Irregular central zones of low signal intensity (tumor [[necrosis]])
| style="background: #F5F5F5; padding: 5px;" |
* We may see [[Atypia|atypical cells]], high [[mitotic]] rate, geographic areas of [[coagulative necrosis]] separated from viable [[neoplasm]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* In case of rapid [[uterine]] growth in post [[Menopause|menopausal]] [[women]] we may suspect [[uterine sarcoma]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pregnancy]]<br><ref name="CacctatoreTttttnen1990">{{cite journal|last1=Cacctatore|first1=Bruno|last2=Tttttnen|first2=Atla|last3=Stenman|first3=Ulf-Hakan|last4=Ylostalo|first4=Pekka|title=Normal early pregnancy: serum hCG levels and vaginal ultrasonography findings|journal=BJOG: An International Journal of Obstetrics and Gynaecology|volume=97|issue=10|year=1990|pages=899–903|issn=1470-0328|doi=10.1111/j.1471-0528.1990.tb02444.x}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* [[Women]] in [[reproductive]] age (15 -45 y/o)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[HCG|BhCG]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[Ultrasound|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
| style="background: #F5F5F5; padding: 5px;" |
* [[Cystic]] structure filled with fluid
* Curvilinear enhancing structure ([[placenta]])
* [[Fetal]] pore
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[History and Physical examination|History]]/<br>[[laboratory]]<br>findings
| style="background: #F5F5F5; padding: 5px;" |
* We do not perform [[CT scan]] and [[MRI]] in [[pregnancy]] but We may unintentionally image the [[pregnancy]] with [[CT scan]] and [[MRI]].
|-
! colspan="14" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Non-gynecologic
|-
| rowspan="4" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Gastrointestinal tract|GIT]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Appendix|Appendiceal]] [[abscess]]<br><ref name="pmid16037513">{{cite journal |vauthors=Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C |title=CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings |journal=AJR Am J Roentgenol |volume=185 |issue=2 |pages=406–17 |date=August 2005 |pmid=16037513 |doi=10.2214/ajr.185.2.01850406 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
* Fluid collection in the [[appendicular]] region
 
* [[appendicolith]] may be visualized.
| style="background: #F5F5F5; padding: 5px;" |
* Fluid collection in the [[appendicular]] region
 
* [[appendicolith]] may be visualized.
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]/<br>[[History and Physical examination|history]]
| style="background: #F5F5F5; padding: 5px;" |
* The most common [[complication]] of [[acute appendicitis]]
* It may cause pleural effusion
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Appendix cancer|Appendiceal  neoplasm]]<br><ref name="WHO">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</ref><ref name="GoedeCaplin2003">{{cite journal|last1=Goede|first1=A. C.|last2=Caplin|first2=M. E.|last3=Winslet|first3=M. C.|title=Carcinoid tumour of the appendix|journal=British Journal of Surgery|volume=90|issue=11|year=2003|pages=1317–1322|issn=0007-1323|doi=10.1002/bjs.4375}}</ref><ref name="Pablo CarmignaniHampton2004">{{cite journal|last1=Pablo Carmignani|first1=C.|last2=Hampton|first2=Regina|last3=E. Sugarbaker|first3=Christina|last4=Chang|first4=David|last5=H. Sugarbaker|first5=Paul|title=Utility of CEA and CA 19-9 tumor markers in diagnosis and prognostic assessment of mucinous epithelial cancers of the appendix|journal=Journal of Surgical Oncology|volume=87|issue=4|year=2004|pages=162–166|issn=0022-4790|doi=10.1002/jso.20107}}</ref><ref name="pmid20587792">{{cite journal |vauthors=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 |title=Cigarette smoking and colorectal cancer risk by molecularly defined subtypes |journal=J. Natl. Cancer Inst. |volume=102 |issue=14 |pages=1012–22 |date=July 2010 |pmid=20587792 |pmc=2915616 |doi=10.1093/jnci/djq201 |url=}}</ref><ref name="pmid2886072">{{cite journal |vauthors=Duh QY, Hybarger CP, Geist R, Gamsu G, Goodman PC, Gooding GA, Clark OH |title=Carcinoids associated with multiple endocrine neoplasia syndromes |journal=Am. J. Surg. |volume=154 |issue=1 |pages=142–8 |date=July 1987 |pmid=2886072 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* 60-70 y/o for [[adenocarcinoma]],
* 30-50 y/o for [[Carcinoid cancer|carcinoid]] tumors
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* In [[adenocarcinoma]] type we may have high levels of [[CEA]] and [[CA 19-9]]
* In [[Carcinoid cancer|carcinoid]] type we may see high levels of [[chromogranin A]], [[5-HIAA]] and Ki67
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see:
** [[Soft tissue]] thickening and Cystic lesion with Internal septation
** Wall irregularity
** [[Calcification]]
** Peri-[[Appendix|appendiceal]] fat stranding
| style="background: #F5F5F5; padding: 5px;" |
* Soft tissue mass in the [[appendix]]
* We may see invasion to other structures
| style="background: #F5F5F5; padding: 5px;" |
* Gray/yellowi color
 
* Cystic structures with angiolymphatic invasion
 
*
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with:
** [[MEN1 syndrome]]
** [[Ulcerative colitis]]
** [[Neurofibromatosis type 1]]
** [[HNPCC]]
** [[Smoking]]
* It may cause pleural effusion
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Diverticular abscess]]<br><ref>{{cite journal|last1=Hulnick|first1=D H|last2=Megibow|first2=A J|last3=Balthazar|first3=E J|last4=Naidich|first4=D P|last5=Bosniak|first5=M A|title=Computed tomography in the evaluation of diverticulitis.|journal=Radiology|volume=152|issue=2|year=1984|pages=491–495|issn=0033-8419|doi=10.1148/radiology.152.2.6739821}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >50 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px;" |
* [[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |
* Ill-defined lesion with air and fluid inside
* Adjacent [[bowel]] loop wall thickening
* Smudged [[mesenteric]] fat
| style="background: #F5F5F5; padding: 5px;" |
* We may see a [[lesion]] with air and fluid inside
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]/<br>[[History and Physical examination|history]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Diverticular abscess]] happens in almost 30-40% of patients with [[diverticulitis]]
* It may cause pleural effusion
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Colorectal cancer]]<br><ref name="ZhuKaneshiro2010">{{cite journal|last1=Zhu|first1=Amy|last2=Kaneshiro|first2=Marc|last3=Kaunitz|first3=Jonathan D.|title=Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective|journal=Digestive Diseases and Sciences|volume=55|issue=3|year=2010|pages=548–559|issn=0163-2116|doi=10.1007/s10620-009-1108-6}}</ref><ref name="pmid10528904">{{cite journal| author=Macdonald JS| title=Carcinoembryonic antigen screening: pros and cons. | journal=Semin Oncol | year= 1999 | volume= 26 | issue= 5 | pages= 556-60 | pmid=10528904 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10528904  }}</ref><ref name="pmid21037809">{{cite journal |vauthors=Haggar FA, Boushey RP |title=Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors |journal=Clin Colon Rectal Surg |volume=22 |issue=4 |pages=191–7 |date=November 2009 |pmid=21037809 |pmc=2796096 |doi=10.1055/s-0029-1242458 |url=}}</ref><ref name="pmid2014406">{{cite journal| author=Taylor AJ, Youker JE| title=Imaging in colorectal carcinoma. | journal=Semin Oncol | year= 1991 | volume= 18 | issue= 2 | pages= 99-110 | pmid=2014406 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2014406  }}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >50 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | –
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/–
| style="background: #F5F5F5; padding: 5px;" |
* [[Anemia]]
* Positive [[Fecal occult blood test]]
* High levels of [[CEA]] and [[CA 19-9]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see luminal narrowing, [[intestinal]] wall thickening,[[intussusception]], [[bowel obstruction]], [[Metastases|hepatic metastases]], intestinal perforation,[[enlarged lymph nodes]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see [[tumor]] mass and the extension of [[tumor]] to other structures
 
* We may see [[metastasis]] to the [[liver]], [[lung]] and [[brain]]
| style="background: #F5F5F5; padding: 5px;" |
* Based on the sub-type we may have different [[histopathological]] feature (for more information [[Colorectal cancer|click here]])
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[smoking]], positive [[family history]], processed meat, low [[Dietary fiber|fiber]] diet, [[Hereditary nonpolyposis colorectal cancer|lynch Syndrome]] and [[familial adenomatous polyposis]]
* They have apple core lesion on [[barium enema]] [[X-ray|xray]]
|-
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Renal]]
[[Bladder]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelvic kidney]]<br><ref name="WeizerSpringhart2005">{{cite journal|last1=Weizer|first1=Alon Z.|last2=Springhart|first2=W. Patrick|last3=Ekeruo|first3=Wesley O.|last4=Matlaga|first4=Brian R.|last5=Tan|first5=Yeh H.|last6=Assimos|first6=Dean G.|last7=Preminger|first7=Glenn M.|title=Ureteroscopic management of renal calculi in anomalous kidneys|journal=Urology|volume=65|issue=2|year=2005|pages=265–269|issn=00904295|doi=10.1016/j.urology.2004.09.055}}</ref><ref name="RossKay1998">{{cite journal|last1=Ross|first1=Jonathan H.|last2=Kay|first2=Robert|title=URETEROPELVIC JUNCTION OBSTRUCTION IN ANOMALOUS KIDNEYS|journal=Urologic Clinics of North America|volume=25|issue=2|year=1998|pages=219–225|issn=00940143|doi=10.1016/S0094-0143(05)70010-0}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−/+
In case of sever [[hydronephrosis]] or [[renal stone]] we may have [[pelvic]] [[pain]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
* In [[sonography]] we may see normal appearing [[kidney]] in [[Pelvis|pelvic]] position
 
* We may see [[renal calculi]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see normal [[kidney]] structure


* [[Ovary]] teratoma
* [[Renal calculi]]
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
* [[Imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* It may cause [[hypertension]]


* Tubal [[pregnancy]]
* It may cause tract infection ([[Urinary tract infection|UTI]]), obstruction, and [[renal calculi]].
* It may be associated with [[RCC]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bladder cancer]]<br><ref name="pmid8797968">{{cite journal |vauthors=Barentsz JO, Jager GJ, Witjes JA, Ruijs JH |title=Primary staging of urinary bladder carcinoma: the role of MRI and a comparison with CT |journal=Eur Radiol |volume=6 |issue=2 |pages=129–33 |date=1996 |pmid=8797968 |doi= |url=}}</ref><ref name="pmid18660854">{{cite journal |vauthors=Shariat SF, Karam JA, Lotan Y, Karakiewizc PI |title=Critical evaluation of urinary markers for bladder cancer detection and monitoring |journal=Rev Urol |volume=10 |issue=2 |pages=120–35 |date=2008 |pmid=18660854 |pmc=2483317 |doi= |url=}}</ref><ref name="pmid10918764">{{cite journal |vauthors=Metts MC, Metts JC, Milito SJ, Thomas CR |title=Bladder cancer: a review of diagnosis and management |journal=J Natl Med Assoc |volume=92 |issue=6 |pages=285–94 |date=June 2000 |pmid=10918764 |pmc=2640522 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* ≥65 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* Low [[red blood cell]] count
* Elevated [[alkaline phosphatase]]
* Positive [[Tumor marker|tumor markers]] such as BTA, NMP, and [[CEA]]
| style="background: #F5F5F5; padding: 5px;" |
* In [[CT scan]] we may see masses protruding into the [[bladder]] lumen or asymmetric thickening of the [[bladder]]
* [[Calcification|calcifications]]
* Nodal [[metastases]]
| style="background: #F5F5F5; padding: 5px;" |
* isointense compared to [[muscle]] in T1


* Ovary adenocarcinoma
* slightly hyperintense compared to [[muscle]] in T2
| style="background: #F5F5F5; padding: 5px;" |
* Based on the sub-type we may have different [[Histopathology|histopathological]] feature (for more information [[Bladder cancer|click here]])
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* It may presents with [[hematuria]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Others
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Retroperitoneum|Retroperitoneal]] [[sarcoma]]<br><ref name="pmid2064467">{{cite journal |vauthors=Storm FK, Mahvi DM |title=Diagnosis and management of retroperitoneal soft-tissue sarcoma |journal=Ann. Surg. |volume=214 |issue=1 |pages=2–10 |date=July 1991 |pmid=2064467 |pmc=1358407 |doi= |url=}}</ref><ref name="pmid16154826">{{cite journal |vauthors=Francis IR, Cohan RH, Varma DG, Sondak VK |title=Retroperitoneal sarcomas |journal=Cancer Imaging |volume=5 |issue= |pages=89–94 |date=August 2005 |pmid=16154826 |doi=10.1102/1470-7330.2005.0019 |url=}}</ref><ref name="SilversteinWakim1964">{{cite journal|last1=Silverstein|first1=Murray N.|last2=Wakim|first2=Khalil G.|last3=Bahn|first3=Robert C.|title=Hypoglycemia associated with neoplasia|journal=The American Journal of Medicine|volume=36|issue=3|year=1964|pages=415–423|issn=00029343|doi=10.1016/0002-9343(64)90168-8}}</ref><ref name="pmid20644672">{{cite journal |vauthors=Storm FK, Mahvi DM |title=Diagnosis and management of retroperitoneal soft-tissue sarcoma |journal=Ann. Surg. |volume=214 |issue=1 |pages=2–10 |date=July 1991 |pmid=2064467 |pmc=1358407 |doi= |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* 40-50 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px; text-align: center;" |−
| style="background: #F5F5F5; padding: 5px;" |
* Mild [[leukocytosis]].
* It may cause [[hypoglycemia]] because of production of [[Insulin-like growth factor|insulinlike]] substances
| style="background: #F5F5F5; padding: 5px;" |
* We may see irregular solid, semisolid, [[Liquefactive necrosis|liquefactive]] areas and patchy [[necrosis]] on [[CT scan]]
| style="background: #F5F5F5; padding: 5px;" |
* We may see [[Retroperitoneum|retroperitoneal]] involvement and degree of [[tumor]] extension
* We may see [[liver]] and [[lung]] [[metastasis]]
| style="background: #F5F5F5; padding: 5px;" |
* There are two types:  [[liposarcoma]] and [[leiomyosarcoma]]
* In [[Liposarcoma|liposarcomas]] we may see background of [[Adipocyte|adipocytes]] with scattered lipoblasts, and [[Inflammatory cells|inflammatory cell]] infiltrate
* In [[leiomyosarcoma]] we may see smooth [[muscle cells]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Biopsy]]
| style="background: #F5F5F5; padding: 5px;" |
* May cause [[lower extremity]] [[edema]], Serous [[ascites]]
* we should perform [[chest]] [[CT scan]] to rule out [[pulmonary]] [[metastases]]
|}
'''ABBREVIATIONS'''


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


==References==
==References==
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[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Gynecology]]
[[Category:Surgery]]

Latest revision as of 19:02, 22 March 2019

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]

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

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
Gynecologic
Ovarian Embryonal carcinoma[4][5][6][7][8]
  • Individuals of any age, especially young adults
+/– +/– _ _ _
Gonadoblastoma
[9][10][11][12][13][14]
  • Individuals of any age,but more common prior to 15 years of age
+/– +/– _ _ _
  • NA
Follicular cysts
[15]
+/– +/–
  • 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
Theca lutein cysts
[16][17][18]
+/– +/–
Serous cystadenoma/carcinoma
[19][20][21][22]
  • >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
[23][24][25]
  • >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
[26][27][28]
+ + +/– +
  • hyperintensity on T1-weighted images and a hypointensity on T2-weighted images
  • Powder burn hemorrhages
Teratoma
[29][30][31][32]
  • 10-30 y/o
+/– +/–
  • We may see evidence of fat components
Dysgerminoma
[33][34]
  • 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
[35][36][37]
+ +
  • 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
[38][39][40]
  • >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
[41][42][43]
  • >50 y/o
+/–
Granulosa cell tumor
[44][45][46][47]
  • 50-60 y/o
+ +/–
Sertoli-leydig cell tumor
[48][49]
  • 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
[50][51]
  • >55 y/o
+/–
  • Hypointense on T2 because of fibrous content
  • Most of the times it's an accidental finding
Krukenberg tumor
[52][53]
  • >55 y/o
+/– +/–

Based on underlying malignancy

Tubal tubo-ovarian abscess
[54][55][56][57]
+ + + +
  • hypointense in T1 and heterogeneous in T2
Ectopic pregnancy
[58]
+ + +/– +
  • NA
  • NA
Hydrosalpinx
[59][60][61]
  • NA
+ +/–
  • NA
Salpingitis
[62]
+ + + +
  • In US we may see , edematous and thickened endosalpingeal folds
  • NA
  • NA
Fallopian tube carcinoma
[63]
  • >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
[64][65]
+ + +/–
  • 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
[66][67][68][69]
+ + +/– +
  • We may see an infiltrative uterine mass and thickening of uterine wall
Leiomyosarcoma
[70][71][72][73][74]
  • >55 y/o
+ + +/–
  • Increased uterine size
  • Irregular central zones of low signal intensity (tumor necrosis)
Pregnancy
[75]
+/− +/− +/−
  • NA
Non-gynecologic
GIT Appendiceal abscess
[76]
  • NA
+ + +/– +
  • NA
Appendiceal neoplasm
[77][78][79][80][81]
+ + +/–
  • Soft tissue mass in the appendix
  • We may see invasion to other structures
  • Gray/yellowi color
  • Cystic structures with angiolymphatic invasion
Diverticular abscess
[82]
  • >50 y/o
+ + +/– +
  • 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
Colorectal cancer
[83][84][85][86]
  • >50 y/o
+ + +/–
  • We may see tumor mass and the extension of tumor to other structures
Renal

Bladder

Pelvic kidney
[87][88]
  • NA
−/+

In case of sever hydronephrosis or renal stone we may have pelvic pain

  • We may see normal kidney structure
  • NA
  • It may cause tract infection (UTI), obstruction, and renal calculi.
  • It may be associated with RCC
Bladder cancer
[89][90][91]
  • ≥65 y/o
+
  • isointense compared to muscle in T1
  • slightly hyperintense compared to muscle in T2
Others Retroperitoneal sarcoma
[92][93][94][95]
  • 40-50 y/o
+ +

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

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