Ovarian Sarcoma: Difference between revisions

Revision as of 17:18, 19 August 2019

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

Overview

Ovarian carcinosarcoma, which is also known as a malignant mixed mullerian tumor (MMMT) of the ovary, is a rare, aggressive cancer of the ovary with two distinct characteristic cancer types i.e carcinoma and sarcoma.Primary ovarian sarcomas occur as pure sarcomas or mixed müllerian tumors (MMTs).Ovarian sarcoma is one of the least common gynecologic malignancy, constituting approximately 1% of all ovarian malignancies.Prognosis is generally poor, and the 5-year survival rate of patients with ovarian sarcoma is approximately 28.2%.Most of the women are asymptomatic, when present, symptoms may include,pain in the abdomen or pelvic area, bloating or swelling of the abdomen, quickly feeling full when eating, other digestive problems. An elevated concentration of CA-125 in serum is seen in some patients of ovarian sarcoma.Biopsy is the study of choice.Findings on MRI suggestive of ovarian sarcoma include the following.Surgery is the mainstay of treatment for ovarian sarcoma.Among all chemotherapeutic regimens that are being used to treat ovarian sarcoma, they are divided into two groups like platinum containing regimens and non-platinum regimens. Cisplatin, carboplatin are commonly used.

Historical Perspective

There is limited information available about the historical perspective of ovarian sarcoma

Classification

There is no established system for the classification of ovarian Sarcoma.^[1]^[2]^[3]

Primary ovarian sarcomas occur as pure sarcomas or mixed müllerian tumors (MMTs).
Pure sarcomas are comprised of a single malignant mesenchymal element and are further categorized as:
- Stromal cell sarcomas
- Fibrosarcomas
- Leiomyosarcomas
- Neurofibrosarcomas
- Rhabdomyosarcomas
- Chondrosarcomas
- Angiosarcomas
- Liposarcomas
On the other hand mixed mullerian tumors(MMTs) are defined by the presence of both carcinomatous and sarcomatous elements and are more common than pure sarcomas.
Ovarian MMTs can be further classified as homologous or heterologous on the basis of the tissue components present.
Homologous tumors contain elements that are native to the ovary whereas heterologous tumors contain elements that normally are not present in the ovary.

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

OR

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

Pathophysiology

The exact pathogenesis of ovarian sarcoma is not fully understood^[4]^[3]
Clonal loss of the wild-type BRCA2 allele as well as the same somatic mutation of the TP53 gene was evident in histologic components

Types of ovarian cancer according to origin,Vargas AN. Natural history of ovarian cancer. Ecancermedicalscience. 2014;8:465. Published 2014 Sep 25. doi:10.3332/ecancer.2014.465,https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4176445/

Causes

The exact causes of ovarian sarcoma have not been identified.

Differentiating ovarian sarcoma from Other Diseases

On the basis of age of onset, vaginal discharge, and constitutional symptoms, ovarian cancer must be differentiated from tubo-ovarian abscess, ectopic pregnancy, hydrosalpinx, salpingitis, fallopian tube carcinoma, uterine leiomyoma, choriocarcinoma, leiomyosarcoma, pregnancy, appendiceal abscess, appendiceal neoplasm, diverticular abscess, colorectal cancer, pelvic kidney, advanced bladder cancer, and retroperitoneal sarcoma.

			Symptoms			Physical examination		Lab Findings	Imaging		Immunohistopathology
Diseases		Clinical manifestations						Para-clinical findings				Gold standard	Additional findings
		Age of onset	Symptoms			Physical examination		Para-clinical findings
			pelvic/abdominal pain or pressure	vaginal bleeding/discharge	GI dysturbance	Fever	Tenderness	Lab Findings	CT scan/US	MRI	Immunohistopathology
Gynecologic
Ovarian	Follicular cysts ^[5]	Women in reproductive age (15 -45 y/o)	+/–	–	–	–	+/–	High level of estrogen +/–	In US we may see a >3 cm simple cyst with no internal echo and with posterior acoustic enhancement	simple cyst with no internal echo or septa	NA	History/ imaging	It is associated with hyperestrogenism and endometrial hyperplasia
	Theca lutein cysts ^[6]^[7]^[8]	Women in reproductive age (15 -45 y/o)	+/–	–	–	–	+/–	Depends on the underlying etiology	In US we may see bilaterally enlarged ovaries with multiple cysts	Multiple bilateral cysts	Theca interna cell Hyperplasia	History/ imaging	It is associated with hydatidiform moles, choriocarcinoma, diabetes mellitus and clomiphene intake (ovulation induction)
	Serous cystadenoma/carcinoma ^[9]^[10]^[11]^[12]	>55 y/o	+/–	–	–	–	+/–	Elevated levels of serum cancer antigen-125	In US we may see simple or multiloculated cyst In serous cystadenocarcinoma we may see papillary projection inside the cyst In serous cystadenocarcinoma we may see ascites	In Serous cystadenoma we may see a simple cyst with beak sign, hypointense on T1 and hyperintense on T2 In serous cystadenocarcinoma we may see some Solid malignant components inside the cyst with intermediate signal on T1 and T2	Cyst wall consist of benign/malignant Fallopian epithelial layer Psammoma body In serous cystadenocarcinoma we may see papillary projection inside the cyst	Biopsy	Most common ovarian neoplasm
	Mucinous cystadenoma/carcinoma ^[13]^[14]^[15]	>55 y/o	+/–	–	–	–	+/–	Elevated levels of serum cancer antigen-125	In US we may see large simple cyst with septation In mucinous cystadenocarcinoma we may see thickened internal septation with solid components inside the cyst	Stained glass appearance due to variable signal intensity on T1 and T2 The more mucin we have, there is more intensity on T1 and less intensity on T2	Cyst wall consist of columnar endocervical epithelium We may see gelatinous mucin inside the cyst	Biopsy	It may cause pseudomyxoma peritonei
	Endometrioma ^[16]^[17]^[18]	Women in reproductive age (15 -45 y/o)	+	+	+/–	–	+	Iron deficiency anemia Elevated levels of serum cancer antigen-125 Increased levels of interleukin 1, chemoattractant protein-1, and interferon gamma	Complex mass on US Increased Doppler flow because of increased vascularture It may present with catamenial pneumothorax, hemothorax, and lung nodules in CT scan.	hyperintensity on T1-weighted images and a hypointensity on T2-weighted images Powder burn hemorrhages	Chocolate cyst	Laparoscopy	It may cause infertility
	Teratoma ^[19]^[20]^[21]^[22]	10-30 y/o	+/–	–	–	–	+/–	High level of HCG and LDH	In US we may see cystic adnexal mass with mural components and echogenic lesion due to calcification The iceberg sign Dot-dash pattern	We may see evidence of fat components	All three germ layers cell	Biopsy	It may cause ovarian torsion May content thyroid tissue and cause hyperthyroidism In plane radiography we may see calcification due to the presence of tooth in the tumor
	Dysgerminoma ^[23]^[24]	in the second to third decade of life	+	+/–	–	–	+/–	High level of HCG and LDH Hypercalcemia	Multilobulated solid masses	We may see ovarian mass with septation which are hyperintense on T1 and hypo or isointense on T2 imaging	Sheets fried egg appearance cells	Biopsy	Same as male seminoma
	Yolk sac tumor ^[25]^[26]^[27]	Young children Male infants	+	–	–	–	+	High levels of AFP	In US we may see a combination of echogenic and hypoechoic components	Ovarian mass with hemorrhagic areas	Yellow appearance Hemorrhagic Schiller-Duval bodies (glomeruli like structures)	Biopsy	The other name is ovarian endodermal sinus tumor
	Fibroma ^[28]^[29]^[30]	>50 y/o	Pulling sensation in the groin	–	–	–	+/–	High levels of CA-125	In CT scan we may see a unilateral mass with poor contrast enhancement	Low signal intensity on T1 and T2 We may see scattered hyperintense areas due to edema or cystic degeneration	Spindle-shaped fibroblast	Biopsy	It may cause Meigs syndrome (ovarian fibroma, ascites, and hydrothorax) It may cause ovarian torsion It may cause pleural effusion
	Thecoma ^[31]^[32]^[33]	>50 y/o	+/–	Postmenopausal bleeding	–	–	–	High level of estrogen	In US we may see non-specific ovarian mass We may see evidence of endometrial hyperplasia due to increased level of estrogen	Hyperintense on T2 T1 intensity depends on the amount of fibrous tissue (fibrous tissue lead to hypointensity)	Lipid-laden stromal cells with pale, vaculolated cytoplasm	Biopsy	We may see endometrial cancer as e result of hyper-estrogenism We may see ovarian fibrothecoma (mixture of fibroma and thecoma)
	Granulosa cell tumor ^[34]^[35]^[36]^[37]	50-60 y/o	+	Postmenopausal bleeding	+/–	–	–	High level of estrogen and progesteron We may see inhibin, calretinin, and Ki-67 on the surface of granulosa tumor cells	In US we may see solid, cystic, or multiloculated solid and cystic mass	We may see solid, cystic, or multiloculated solid and cystic mass	Call-Exner bodies	Biopsy	In postmenopausal women may cause breast tenderness
	Sertoli-leydig cell tumor ^[38]^[39]	15 to 35 y/o	+/–	–	–	–	–	Elevated serum testosterone level Elevated alpha-fetoprotein	In US we may see unilateral Well-defined hypoechoic lesion	Low T2 signal intensity areas of high signal intensity	Lydig cells (Polygonal pink cells with eosinophilic cytoplasm Sertoli cells (clear vacuolated cytoplasm)	Biopsy	It may cause virilization symptoms and amenorrhea
	Brenner tumor ^[40]^[41]	>55 y/o	+/–	–	–	–	–	–	In US we may see hypoechoic solid mass and calcification	Hypointense on T2 because of fibrous content	Yellow/pale appearance Transitional cell tumor (resembles bladder) Coffee bean nuclei on H&E	Biopsy	Most of the times it's an accidental finding
	Krukenberg tumor ^[42]^[43]	>55 y/o	+/–	–	+/– Based on underlying malignancy	–	–	In case of metastatic GI cancers we may see iron deficiency anemia	Mostly bilateral, complex ovarian lesion In CT scan we may see evidence of concurrent malignancy in other organs	Mostly bilateral, complex ovarian lesion with solid components Internal hyperintensity on T1 and T2 weighted MR images because of mucin Evidence of concurrent malignancy in other organs	Mucin-secreting signet cell	Imaging/ biopsy	The most common primary tumor is in colon, stomach, breast, lung, and contralateral ovary Based on underlying malignancy it may cause pleural effusion
Tubal	tubo-ovarian abscess ^[44]^[45]^[46]^[47]	Young women (15-30 y/o	+	+	–	+	+	High levels of inflammatory markers Leukocytosis	In US we may see multilocular complex lesion mostly bilateral with debry inside	We may see a pelvic mass filled with fluid with thick walls hypointense in T1 and heterogeneous in T2	In abscess aspiration we may see anaerobic organisms	History/ imaging	The most common risk factors are previous PID, diabetes mellitus, intrauterine device and history of uterine surgery
	Ectopic pregnancy ^[48]	Women in reproductive age (15 -45 y/o)	+	+	+/–	–	+	High level of BhCG Progesterone level ≤5 ng/ml	In US we may see empty uterine cavity, tubal ring sign, ring of fire sign (Doppler), extra-uterine fetal heart rate	NA	NA	History/ imaging	Any women in reproductive age presenting with abdominal pain or amenorrhea should be screened for ectopic pregnancy
	Hydrosalpinx ^[49]^[50]^[51]	NA	+	–	–	–	+/–	–	In US we may see tubal longitudinal folds thickening (cogwheel appearance) In CT scan we may see tubular adnexal lesion with fluid attenuation	Dilated Fallopian tube with fluid signal intensity	NA	Imaging	It is associated with endometriosis (haematosalpinx), ovulation induction, pelvic inflammatory disease, post-hysterectomy, tubal ligation, and tubal malignancy It may cause infertility
	Salpingitis ^[52]	Women of reproductive age	+	+	–	+	+	Leukocytosis	In US we may see , edematous and thickened endosalpingeal folds	NA	NA	History/ physical exam	It may cause infertility
	Fallopian tube carcinoma ^[53]	>60 y/o	+	+	+	–	+/–	High levels of CA125	US findings are non specific (complex mass on Fallopian tube We may see papillary projections	Low signal on T1 In case of hemorrhage inside the tumor we may see high signal intensity on T1 Low or of intermediate signal on T2 In case of serous fluid inside the tumor we may see high signal intensity on T2	Based on the tumor type we may have different biopsy finding	Biopsy	We may see Latzko triad (abdominal pain, vaginal discgarge, pelvic mass) It may cause pleural effusion
Uterine	Leiomyoma ^[54]^[55]	Women of reproductive age	+	+	–	–	+/–	In chronic cases, we may see mild anemia	In US we may see hypoechoic mass with calcification and cystic areas of necrosis or degeneration may	Low to intermediate signal intensity on T1 and T2 In case of necrosis inside the mass, there might be some high signal lesions on T2	Smooth muscle	Imaging	It may cause infertility
	Choriocarcinoma ^[56]^[57]^[58]^[59]	Women in reproductive age (15 -45 y/o)	+	+	+/–	–	+	High level of B-hCG	In US we may see heterogeneous mass infiltrating myometrium Enlarged uterus Necrosis + Hemorrhage + In CT scan we may see evidence of metastasis to brain, lung and other organs	We may see an infiltrative uterine mass and thickening of uterine wall	Trophoblastic tissue origin columns and sheets of trophoblastic tissue invading uterine muscle and blood vessels	Biopsy		It is associated with bilateral theca lutein cysts Cannonball metastases to the lungs May cause hemoptysis We may see passing of grapes like tissue from the vagina
	Leiomyosarcoma ^[60]^[61]^[62]^[63]^[64]	>55 y/o	+	+	–	–	+/–	In some cases we may see elevated levels of CA-125 lactate dehydrogenase	Heterogeneous mass with central low attenuation (necrosis) and calcification.	Increased uterine size Irregular central zones of low signal intensity (tumor necrosis)	We may see atypical cells, high mitotic rate, geographic areas of coagulative necrosis separated from viable neoplasm	Biopsy	In case of rapid uterine growth in post menopausal women we may suspect uterine sarcoma
	Pregnancy ^[65]	Women in reproductive age (15 -45 y/o)	+/−	+/−	+/−	–	–	High level of BhCG	In US we may see gestational sac, yolk sac, double bleb sign and fetal pore In CT scan we may see cystic structure filled with fluid, curvilinear enhancing structure (placenta) and fetal pore	Cystic structure filled with fluid Curvilinear enhancing structure (placenta) Fetal pore	NA	History/ laboratory findings	We do not perform CT scan and MRI in pregnancy but We may unintentionally image the pregnancy with CT scan and MRI.
Non-gynecologic
GIT	Appendiceal abscess ^[66]	NA	+	–	+	+/–	+	Leukocytosis	Fluid collection in the appendicular region appendicolith may be visualized.	Fluid collection in the appendicular region appendicolith may be visualized.	NA	Imaging/ history	The most common complication of acute appendicitis It may cause pleural effusion
	Appendiceal neoplasm ^[67]^[68]^[69]^[70]^[71]	60-70 y/o for adenocarcinoma, 30-50 y/o for carcinoid tumors	+	–	+	–	+/–	In adenocarcinoma type we may have high levels of CEA and CA 19-9 In carcinoid type we may see high levels of chromogranin A, 5-HIAA and Ki67	In CT scan we may see: Soft tissue thickening and Cystic lesion with Internal septation Wall irregularity Calcification Peri-appendiceal fat stranding	Soft tissue mass in the appendix We may see invasion to other structures	Gray/yellowi color Cystic structures with angiolymphatic invasion	Biopsy	It is associated with: MEN1 syndrome Ulcerative colitis Neurofibromatosis type 1 HNPCC Smoking It may cause pleural effusion

Epidemiology and Demographics

Ovarian sarcoma is one of the least common gynecologic malignancy, constituting approximately 1% of all ovarian malignancies.^[1]^[72]^[73]^[74]^[75]^[76]
In 2012, approximately 239,000 women were diagnosed with ovarian cancer worldwide, and 152,000 died of the disease.
Patients of all age groups may develop sarcoma of the ovary both postmenopausal and premenopausal women.
The incidence of ovarian Sarcoma increases with age; the median age at diagnosis is 50-60 years.
There is no racial predilection to ovarian Sarcoma

Risk Factors

There are no established risk factors for ovarian sarcoma

Screening

There is insufficient evidence to recommend routine screening for ovarian sarcoma.

Natural History, Complications, and Prognosis

Ovarian carcinosarcomas follow a distinct natural history compared to other more common epithelial carcinomas^[77]^[3]^[78]^[79]
Ovarian carcinosarcomas are aggressive neoplasms with a predilection towards early dissemination.
Prognostic factors for this tumor type remain unclear because of its rarity.
Prognosis is generally poor, and the 5-year survival rate of patients with ovarian sarcoma is approximately 28.2%.
Some possible factors such as age and menopausal status have been proposed.

Diagnostic Study of Choice

There are no established criteria for the diagnosis of ovarian sarcoma
Biopsy is the study of choice

History and Symptoms

Most of the women are asymptomatic, when present, symptoms may include:^[80]^[81]^[82]

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

Physical Examination

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

OR

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

OR

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

OR

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

Laboratory Findings

An elevated concentration of CA-125 in serum is seen in some patients of ovarian sarcoma.^[83]^[84]^[85]
There are no diagnostic laboratory findings associated with ovarian sarcoma.

Electrocardiogram

There are no ECG findings associated with ovarian sarcoma.

X-ray

There are no x-ray findings associated with ovarian Sarcoma.

Echocardiography or Ultrasound

There are no echocardiography/ultrasound findings associated with ovarian Sarcoma.

CT scan

CT scan may be helpful in the diagnosis of ovarian sarcoma . Findings on CT scan suggestive of ovarian sarcoma include:^[86]^[87]^[88]

MRI

MRI may be helpful in the diagnosis of ovarian sarcoma. Findings on MRI suggestive of ovarian sarcoma include the following:^[89]^[86]^[88]^[90]^[87]

Other Imaging Findings

There are no other imaging findings associated with ovarian sarcoma

Other Diagnostic Studies

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

OR

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

OR

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

Treatment

Medical Therapy

There is no medical treatment for ovarian sarcoma, the mainstay of therapy is surgery and chemotherapy.

Surgery

Surgery is the mainstay of treatment for ovarian sarcoma.
The management is similar to that of epithelial carcinoma of ovary, consisting of cytoreductive surgery followed by adjuvant chemotherapy.

Chemotherapy

Chemotherapy with various regimens has been used in different centers without defined conclusions on efficacy^[81]^[82]^[91]^[92]^[93]
Multiple chemotherapeutic regimens have been evaluated with modest response rates ranging from 12% to 100%.
Among all chemotherapeutic regimens that are being used, they are divided into two groups like platinum containing regimens and non-platinum regimens.
- Platinum containing chemotherapy regimens

Carboplatin and ifosfamide (Carbo-I)
Carboplatin (Carbo)
Cyclophosphamide, adriamycin and cisplatin (CAP)
Carboplatin and cyclophosphamide (Carbo-C)
Epirubicin, carboplatin and 5FU (E-Carbo-F)
Epirubicin, cisplatin and 5FU (ECF)
Taxol and Carboplatin (T-Carbo)

Other chemotherapy regimens

Doxorubicin (A)
Doxorubicin and cyclophosphamide (AC)
Cyclophosphamide (IV)
Cyclophosphamide (oral)
Melphalan

Primary Prevention

There are no established measures for the primary prevention of ovarian sarcoma.

Secondary Prevention

There are no established measures for the secondary prevention of ovarian sarcoma.

References

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@@ Line 44: / Line 44: @@
 ==Differentiating ovarian sarcoma from Other Diseases==
-[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
+On the basis of age of onset, [[vaginal discharge]], and constitutional symptoms, ovarian cancer must be differentiated from [[tubo-ovarian abscess]], [[ectopic pregnancy]], [[hydrosalpinx]], [[salpingitis]], [[fallopian tube]] [[carcinoma]], [[uterine leiomyoma]], [[choriocarcinoma]], [[leiomyosarcoma]], [[pregnancy]], [[Appendix|appendiceal]] [[abscess]], [[Appendiceal cancer|appendiceal neoplasm]], [[diverticular abscess]], [[colorectal cancer]], [[pelvic kidney]], advanced [[bladder cancer]], and [[retroperitoneal]] [[sarcoma]].
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
@@ Line 68: / Line 69: @@
 ! 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="14" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovary|Ovarian]]
+| 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>
@@ Line 176: / Line 223: @@
 * 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>
@@ Line 225: / Line 375: @@
 | 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]]
@@ Line 251: / Line 448: @@
 | 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>
@@ Line 356: / Line 619: @@
 | 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
-OR
+* Cystic structures with angiolymphatic invasion
-[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
+*
+| 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
+|}
 ==Epidemiology and Demographics==