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==Overview==
==Overview==
[[Surgical]] [[intervention]] is the mainstay of management of [[ovarian]] [[germ cell]] [[tumors]]. [[Surgery]] must be done for the purpose of [[Cancer staging|staging]] and maybe treatment according to the stage of the tumor.
[[Surgical]] [[intervention]] is the mainstay of management of [[ovarian]] [[germ cell]] [[tumors]]. [[Surgery]] is recommended both for [[Cancer staging|staging]] and choosing appropriate treatment approaches. accordingly.  
[[Surgical]] management of the [[ovarian]] [[germ cell]] [[tumors]], for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the [[ovary]] or not. [[Surgery]] is the mainstay of treatment for [[Mature cystic teratoma|mature teratoma]].
[[Surgical]] management of the [[ovarian]] [[germ cell]] [[tumors]], for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the [[ovary]] or not.  
==Surgery==
==Surgery==
* [[Surgery]] is the mainstay of management of [[ovrian]] [[germ cell]] [[tumors]]:<ref name="xxx">Stage I Ovarian Germ Cell Tumors
* [[Surgery]] is the mainstay of management of [[ovarian]] [[germ cell]] [[tumors]].<ref name="xxx">Stage I Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015</ref><ref name="aaa">Stage III Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015</ref><ref name="aaa">Stage III Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name="ccc">Stage IV Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name="ccc">Stage IV Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
* [[Surgery]] is [[Indication (medicine)|indicated]] for the purpose of [[Staging (pathology)|staging]] and maybe treatment according to the stage of the [[tumor]].<ref name="Gershenson2007">{{cite journal|last1=Gershenson|first1=David M.|title=Management of Ovarian Germ Cell Tumors|journal=Journal of Clinical Oncology|volume=25|issue=20|year=2007|pages=2938–2943|issn=0732-183X|doi=10.1200/JCO.2007.10.8738}}</ref>
* [[Surgery]] is recommended both for [[Cancer staging|staging]] and choosing appropriate treatment approaches. accordingly.<ref name="Gershenson2007">{{cite journal|last1=Gershenson|first1=David M.|title=Management of Ovarian Germ Cell Tumors|journal=Journal of Clinical Oncology|volume=25|issue=20|year=2007|pages=2938–2943|issn=0732-183X|doi=10.1200/JCO.2007.10.8738}}</ref>
* [[Surgical]] management of the [[ovarian]] [[germ cell]] [[tumors]], for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the [[ovary]] or not.
* [[Surgical]] options depends upon the choice of preserving fertility.
===Mature teratoma===
{| class="wikitable"
|+
!
!
!
|-
|Mature Teratoma
|
*[[Surgery]] is the mainstay of [[treatment]] for [[Mature cystic teratoma|mature teratoma]].<ref name="Yayla AbideBostancı Ergen2018">{{cite journal|last1=Yayla Abide|first1=Çiğdem|last2=Bostancı Ergen|first2=Evrim|title=Retrospective analysis of mature cystic teratomas in a single center and review of the literature|journal=Journal of Turkish Society of Obstetric and Gynecology|volume=15|issue=2|year=2018|pages=95–98|issn=1307699X|doi=10.4274/tjod.86244}}</ref>
*[[Surgery]] is the mainstay of [[treatment]] for [[Mature cystic teratoma|mature teratoma]].<ref name="Yayla AbideBostancı Ergen2018">{{cite journal|last1=Yayla Abide|first1=Çiğdem|last2=Bostancı Ergen|first2=Evrim|title=Retrospective analysis of mature cystic teratomas in a single center and review of the literature|journal=Journal of Turkish Society of Obstetric and Gynecology|volume=15|issue=2|year=2018|pages=95–98|issn=1307699X|doi=10.4274/tjod.86244}}</ref>
*Nonsurgical management may be considered in those with [[tumors]] smaller than 6 cm, especially those who is planning to get [[pregnant]].<ref name="CaspiAppelman1997">{{cite journal|last1=Caspi|first1=Benjamin|last2=Appelman|first2=Zvi|last3=Rabinerson|first3=David|last4=Zalel|first4=Yaron|last5=Tulandi|first5=Togas|last6=Shoham|first6=Zeev|title=The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women|journal=Fertility and Sterility|volume=68|issue=3|year=1997|pages=501–505|issn=00150282|doi=10.1016/S0015-0282(97)00228-8}}</ref>
*Nonsurgical management may be considered in those with [[tumors]] smaller than 6 cm, especially those who is planning to get [[pregnant]].<ref name="CaspiAppelman1997">{{cite journal|last1=Caspi|first1=Benjamin|last2=Appelman|first2=Zvi|last3=Rabinerson|first3=David|last4=Zalel|first4=Yaron|last5=Tulandi|first5=Togas|last6=Shoham|first6=Zeev|title=The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women|journal=Fertility and Sterility|volume=68|issue=3|year=1997|pages=501–505|issn=00150282|doi=10.1016/S0015-0282(97)00228-8}}</ref>
*[[Surgery]] increses the risk of [[Adhesions|band adhesion]] formation that may be associated with future [[fertility]] in women.
*[[Surgery]] increases the risk of [[Adhesions|band adhesion]] formation that may be associated with future [[fertility|infertility]] in women.
*[[Surgery]] is usually reserved for patients with either:<ref name="CaspiAppelman1997">{{cite journal|last1=Caspi|first1=Benjamin|last2=Appelman|first2=Zvi|last3=Rabinerson|first3=David|last4=Zalel|first4=Yaron|last5=Tulandi|first5=Togas|last6=Shoham|first6=Zeev|title=The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women|journal=Fertility and Sterility|volume=68|issue=3|year=1997|pages=501–505|issn=00150282|doi=10.1016/S0015-0282(97)00228-8}}</ref>
*[[Surgery]] is usually reserved for patients with either:<ref name="CaspiAppelman1997" />
**[[Tumor]] size larger than 6 cm
**[[Tumor]] size larger than 6 cm
**No plans for future [[pregnancy]]
**No plans for future [[pregnancy]]
**[[Menopausal|Post-menopausal]] women
**[[Menopausal|Post-menopausal]] women
===Dysgerminoma===
|
* [[Surgery]] is the mainstay of treatment in [[Dysgerminoma|dysgerminomas]]. Additional [[chemotherapy]] and/or [[radiotherapy]] depend on the [[stage]] of the [[tumor]].<ref name="VicusBeiner2010">{{cite journal|last1=Vicus|first1=Danielle|last2=Beiner|first2=Mario E.|last3=Klachook|first3=Shany|last4=Le|first4=Lisa W.|last5=Laframboise|first5=Stephane|last6=Mackay|first6=Helen|title=Pure dysgerminoma of the ovary 35 years on: A single institutional experience|journal=Gynecologic Oncology|volume=117|issue=1|year=2010|pages=23–26|issn=00908258|doi=10.1016/j.ygyno.2009.12.024}}</ref>
|-
!
!Management of [[Dysgerminoma|Dysgerminomas]]<ref name="xxx" /><ref name="abc" /><ref name="aaa" /><ref name="ccc" />
!Other tumors
|-
|Stage I ovarian germ cell tumors
|
* Unilateral [[salpingo-oophorectomy]] with or without [[lymphangiography ]]or [[computed tomography]] ([[CT]])
* Unilateral [[salpingo-oophorectomy]] followed by [[observation]]
* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[radiation therapy]] or [[chemotherapy]]
* Unilateral [[salpingo-oophorectomy]] with conservation of [[uterus]] and contralateral [[ovar]] is [[Indication (medicine)|indicated]] in those who plan for future [[pregnancies]].
* Postoperative [[lymphangiography]] or [[CT]] is [[Indication (medicine)|indicated]] for those who have not had the careful [[surgical]] and [[pathological]] examination of [[pelvic]] and [[Paraaortic lymph nodes|para-aortic lymph nodes]] during [[surgery]].
* Patients with [[Surgery|surgically]] staged stage IA [[tumors]] may be observed carefully after [[surgery]] without the need for [[adjuvant treatment]].
* Patients with incompletely staged [[tumor]] through [[surgery]] or those with higher stages may need [[adjuvant treatment]].
|
|-
|Stage II ovarian germ cell tumors
|
* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[radiation]] therapy or [[chemotherapy]]
* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
** This option is considered for younger patients and those who desire to preserve their [[fertility]] for future [[pregnancies]].
** [[Radiotherapy]] has been associated with [[ovarian failure]].
** [[Adjuvant]] [[chemotherapy]] with the [[platinum]]-based regimen has replaced [[radiation therapy]] except in the rare patient in whom [[chemotherapy]] is not considered appropriate.
|
|-
|Stage III ovarian germ cell tumors
|
:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant chemotherapy]]
:* Second-look [[laparotomy]]
:** This strategy is not beneficial in patients with completely resected [[tumors]] who receive [[cisplatin]]-based [[adjuvant treatment]].
:** Second-look [[surgery]] may be beneficial in those whose [[tumor]] was not completely resected at the initial [[surgical]] procedure and who had teratomatous elements in their primary [[tumor]].
|
|-
|Stage IV ovarian germ cell tumors
|
:* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]]
:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
:** [[Chemotherapy]] is the preferred treatment in the patient who wants to preserve [[fertility]].
|
|}
 
===Mature teratoma===
**
===Management of ===
* [[Surgery]] is the mainstay of treatment in [[Dysgerminoma|dysgerminomas]].  
* Depending upon the staging and severity adjuavant Additional [[chemotherapy]] and/or [[radiotherapy]] depend on the [[stage]] of the [[tumor]].<ref name="VicusBeiner2010">{{cite journal|last1=Vicus|first1=Danielle|last2=Beiner|first2=Mario E.|last3=Klachook|first3=Shany|last4=Le|first4=Lisa W.|last5=Laframboise|first5=Stephane|last6=Mackay|first6=Helen|title=Pure dysgerminoma of the ovary 35 years on: A single institutional experience|journal=Gynecologic Oncology|volume=117|issue=1|year=2010|pages=23–26|issn=00908258|doi=10.1016/j.ygyno.2009.12.024}}</ref>
* Stage 1A: [[fertility]]-preserving [[surgery]] without [[adjuvant]] [[chemotherapy]] or [[radiotherapy]].<ref name="AL HusainiSoudy2012">{{cite journal|last1=AL Husaini|first1=Hamed|last2=Soudy|first2=Hussein|last3=Darwish|first3=Alaa El Din|last4=Ahmed|first4=Mohamed|last5=Eltigani|first5=Amin|last6=AL Mubarak|first6=Mustafa|last7=Sabaa|first7=Amal Abu|last8=Edesa|first8=Wael|last9=AL-Tweigeri|first9=Taher|last10=Al-Badawi|first10=Ismail A.|title=Pure dysgerminoma of the ovary: a single institutional experience of 65 patients|journal=Medical Oncology|volume=29|issue=4|year=2012|pages=2944–2948|issn=1357-0560|doi=10.1007/s12032-012-0194-z}}</ref>
* Stage 1A: [[fertility]]-preserving [[surgery]] without [[adjuvant]] [[chemotherapy]] or [[radiotherapy]].<ref name="AL HusainiSoudy2012">{{cite journal|last1=AL Husaini|first1=Hamed|last2=Soudy|first2=Hussein|last3=Darwish|first3=Alaa El Din|last4=Ahmed|first4=Mohamed|last5=Eltigani|first5=Amin|last6=AL Mubarak|first6=Mustafa|last7=Sabaa|first7=Amal Abu|last8=Edesa|first8=Wael|last9=AL-Tweigeri|first9=Taher|last10=Al-Badawi|first10=Ismail A.|title=Pure dysgerminoma of the ovary: a single institutional experience of 65 patients|journal=Medical Oncology|volume=29|issue=4|year=2012|pages=2944–2948|issn=1357-0560|doi=10.1007/s12032-012-0194-z}}</ref>


===Stage I ovarian germ cell tumors===
**  
* [[Dysgerminoma|Dysgerminomas]]<ref name="xxx">Stage I Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015</ref><ref name="aaa">Stage III Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name="ccc">Stage IV Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
** Unilateral [[salpingo-oophorectomy]] with or without [[lymphangiography ]]or [[computed tomography]] ([[CT]])
** Unilateral [[salpingo-oophorectomy]] followed by [[observation]]
** Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[radiation therapy]] or [[chemotherapy]]
** Unilateral [[salpingo-oophorectomy]] with conservation of [[uterus]] and contralateral [[ovar]] is [[Indication (medicine)|indicated]] in those who plan for future [[pregnancies]].
** Postoperative [[lymphangiography]] or [[CT]] is [[Indication (medicine)|indicated]] for those who have not had the careful [[surgical]] and [[pathological]] examination of [[pelvic]] and [[Paraaortic lymph nodes|para-aortic lymph nodes]] during [[surgery]].
** Patients with [[Surgery|surgically]] staged stage IA [[tumors]] may be observed carefully after [[surgery]] without the need for [[adjuvant treatment]].
** Patients with incompletely staged [[tumor]] through [[surgery]] or those with higher stages may need [[adjuvant treatment]].
* Other [[germ cell]] [[tumors]]
* Other [[germ cell]] [[tumors]]
:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant chemotherapy]]
:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant chemotherapy]]
Line 44: Line 84:
:* Unilateral [[salpingo-oophorectomy]] with conservation of [[uterus]] and contralateral [[ovar]] is [[Indication (medicine)|indicated]] in those who plan for future [[pregnancies]].
:* Unilateral [[salpingo-oophorectomy]] with conservation of [[uterus]] and contralateral [[ovar]] is [[Indication (medicine)|indicated]] in those who plan for future [[pregnancies]].
:* [[Chemotherapy agent|Chemotherapy]] is usually done postoperatively in those with [[ovarian]] [[germ cell]] [[tumors]] other than pure [[dysgerminoma]] and low grade (grade 1) immature [[teratoma]], but it can also preserved for those whose [[tumors]] [[relapse]] after the [[surgery]].
:* [[Chemotherapy agent|Chemotherapy]] is usually done postoperatively in those with [[ovarian]] [[germ cell]] [[tumors]] other than pure [[dysgerminoma]] and low grade (grade 1) immature [[teratoma]], but it can also preserved for those whose [[tumors]] [[relapse]] after the [[surgery]].
===Stage II ovarian germ cell tumors===
 
* [[Dysgerminoma|Dysgerminomas]]<ref name="xxx">Stage I Ovarian Germ Cell Tumors
*  
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
:**  
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015</ref><ref name="aaa">Stage III Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name="ccc">Stage IV Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
:* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[radiation]] therapy or [[chemotherapy]]
:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
:** This option is considered for younger patients and those who desire to preserve their [[fertility]] for future [[pregnancies]].
:** [[Radiotherapy]] has been associated with [[ovarian failure]].
:** [[Adjuvant]] [[chemotherapy]] with the [[platinum]]-based regimen has replaced [[radiation therapy]] except in the rare patient in whom [[chemotherapy]] is not considered appropriate.
* Other [[germ cell]] [[tumors]]
* Other [[germ cell]] [[tumors]]
:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant chemotherapy]]
:* Second-look [[laparotomy]]
:** This strategy is not beneficial in patients with completely resected [[tumors]] who receive [[cisplatin]]-based [[adjuvant treatment]].
:** Second-look [[surgery]] may be beneficial in those whose [[tumor]] was not completely resected at the initial [[surgical]] procedure and who had teratomatous elements in their primary [[tumor]].


===Stage III ovarian germ cell tumors===
* [[Dysgerminoma|Dysgerminomas]]<ref name="xxx">Stage I Ovarian Germ Cell Tumors
* [[Dysgerminoma|Dysgerminomas]]<ref name="xxx">Stage I Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
Line 67: Line 94:
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name="ccc">Stage IV Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015</ref><ref name="ccc">Stage IV Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015</ref>
:* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]]
:*  
:* Unilateral [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]]
:** [[Chemotherapy]] is the preferred treatment in the patient who wants to preserve [[fertility]].
* Other [[germ cell]] [[tumors]]
* Other [[germ cell]] [[tumors]]
:* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]], with or without [[neoadjuvant chemotherapy]]
:* Total [[abdominal]] [[hysterectomy]] and [[bilateral]] [[salpingo-oophorectomy]] with [[adjuvant]] [[chemotherapy]], with or without [[neoadjuvant chemotherapy]]
Line 75: Line 100:
:* Second-look [[laparotomy]]
:* Second-look [[laparotomy]]


===Stage IV ovarian germ cell tumors===
* [[Dysgerminoma|Dysgerminomas]]<ref name="xxx">Stage I Ovarian Germ Cell Tumors
* [[Dysgerminoma|Dysgerminomas]]<ref name="xxx">Stage I Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors
. http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015</ref><ref name="abc">Stage II Ovarian Germ Cell Tumors

Revision as of 23:32, 10 April 2019

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

Overview

Surgical intervention is the mainstay of management of ovarian germ cell tumors. Surgery is recommended both for staging and choosing appropriate treatment approaches. accordingly. Surgical management of the ovarian germ cell tumors, for the purpose of treatment, classified to two categories according to the preference of the patient to preserve the ovary or not.

Surgery

Mature Teratoma
Management of Dysgerminomas[1][2][3][4] Other tumors
Stage I ovarian germ cell tumors
Stage II ovarian germ cell tumors
Stage III ovarian germ cell tumors
Stage IV ovarian germ cell tumors

Mature teratoma

Management of

References

  1. ↑ 1.0 1.1 1.2 1.3 Stage I Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_33. URL Accessed on Nov 5, 2015
  2. ↑ 2.0 2.1 2.2 2.3 Stage II Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_43. URL Accessed on Nov 5, 2015
  3. ↑ 3.0 3.1 3.2 3.3 Stage III Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_54. URL Accessed on Nov 5, 2015
  4. ↑ 4.0 4.1 4.2 4.3 Stage IV Ovarian Germ Cell Tumors . http://www.cancer.gov/types/ovarian/hp/ovarian-germ-cell-treatment-pdq#section/_65. URL Accessed on Nov 5, 2015
  5. ↑ Gershenson, David M. (2007). "Management of Ovarian Germ Cell Tumors". Journal of Clinical Oncology. 25 (20): 2938–2943. doi:10.1200/JCO.2007.10.8738. ISSN 0732-183X.
  6. ↑ Yayla Abide, Çiğdem; Bostancı Ergen, Evrim (2018). "Retrospective analysis of mature cystic teratomas in a single center and review of the literature". Journal of Turkish Society of Obstetric and Gynecology. 15 (2): 95–98. doi:10.4274/tjod.86244. ISSN 1307-699X.
  7. ↑ 7.0 7.1 Caspi, Benjamin; Appelman, Zvi; Rabinerson, David; Zalel, Yaron; Tulandi, Togas; Shoham, Zeev (1997). "The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women". Fertility and Sterility. 68 (3): 501–505. doi:10.1016/S0015-0282(97)00228-8. ISSN 0015-0282.
  8. ↑ Vicus, Danielle; Beiner, Mario E.; Klachook, Shany; Le, Lisa W.; Laframboise, Stephane; Mackay, Helen (2010). "Pure dysgerminoma of the ovary 35 years on: A single institutional experience". Gynecologic Oncology. 117 (1): 23–26. doi:10.1016/j.ygyno.2009.12.024. ISSN 0090-8258.
  9. ↑ AL Husaini, Hamed; Soudy, Hussein; Darwish, Alaa El Din; Ahmed, Mohamed; Eltigani, Amin; AL Mubarak, Mustafa; Sabaa, Amal Abu; Edesa, Wael; AL-Tweigeri, Taher; Al-Badawi, Ismail A. (2012). "Pure dysgerminoma of the ovary: a single institutional experience of 65 patients". Medical Oncology. 29 (4): 2944–2948. doi:10.1007/s12032-012-0194-z. ISSN 1357-0560.

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