Ovarian germ cell tumor differential diagnosis

Jump to: navigation, search
Home logo1.png

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]


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
Ovarian Embryonal carcinoma[4][5][6][7][8]
  • Individuals of any age, especially young adults
+/– +/– _ _ _
  • Individuals of any age,but more common prior to 15 years of age
+/– +/– _ _ _
  • NA
Follicular cysts
+/– +/–
  • 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
+/– +/–
Serous cystadenoma/carcinoma
  • >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
  • >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
+ + +/– +
  • hyperintensity on T1-weighted images and a hypointensity on T2-weighted images
  • Powder burn hemorrhages
  • 10-30 y/o
+/– +/–
  • We may see evidence of fat components
  • 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
+ +
  • High levels of AFP
  • In US we may see a combination of echogenic and hypoechoic components
  • Yellow appearance
  • Schiller-Duval bodies (glomeruli like structures)
  • >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
  • >50 y/o
Granulosa cell tumor
  • 50-60 y/o
+ +/–
Sertoli-leydig cell tumor
  • 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
  • >55 y/o
  • Hypointense on T2 because of fibrous content
  • Most of the times it's an accidental finding
Krukenberg tumor
  • >55 y/o
+/– +/–

Based on underlying malignancy

Tubal tubo-ovarian abscess
+ + + +
  • hypointense in T1 and heterogeneous in T2
Ectopic pregnancy
+ + +/– +
  • NA
  • NA
  • NA
+ +/–
  • NA
+ + + +
  • In US we may see , edematous and thickened endosalpingeal folds
  • NA
  • NA
Fallopian tube carcinoma
  • >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
+ + +/–
  • 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
+ + +/– +
  • We may see an infiltrative uterine mass and thickening of uterine wall
  • >55 y/o
+ + +/–
  • Increased uterine size
  • Irregular central zones of low signal intensity (tumor necrosis)
+/− +/− +/−
  • NA
GIT Appendiceal abscess
  • NA
+ + +/– +
  • NA
Appendiceal neoplasm
+ + +/–
  • Soft tissue mass in the appendix
  • We may see invasion to other structures
  • Gray/yellowi color
  • Cystic structures with angiolymphatic invasion
Diverticular abscess
  • >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
  • >50 y/o
+ + +/–
  • We may see tumor mass and the extension of tumor to other structures


Pelvic kidney
  • 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
  • ≥65 y/o
  • isointense compared to muscle in T1
  • slightly hyperintense compared to muscle in T2
Others Retroperitoneal sarcoma
  • 40-50 y/o
+ +


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


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