{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:17:12Z","timestamp":1785338232421,"version":"3.55.0"},"reference-count":48,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe the clinical and ultrasound characteristics of three types of rare malignant ovarian germ cell tumor: embryonal carcinoma, non\u2010gestational choriocarcinoma and malignant mixed germ cell tumor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histological diagnosis of ovarian embryonal carcinoma, non\u2010gestational choriocarcinoma or malignant mixed germ cell tumor, who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2000 and 2020. Additional patients with the same histology were identified from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. Three examiners reviewed all available ultrasound images and described them using pattern recognition<jats:italic>.<\/jats:italic><\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One patient with embryonal carcinoma, five patients with non\u2010gestational ovarian choriocarcinoma and seven patients with ovarian malignant mixed germ cell tumor (six primary tumors and one recurrence) were identified. Seven patients were included in the IOTA studies and six patients were examined outside of the IOTA studies. The median age at diagnosis was 26 (range, 14\u201377) years. Beta\u2010human chorionic gonadotropin levels were highest in non\u2010gestational choriocarcinomas and alpha\u2010fetoprotein levels were highest in malignant mixed germ cell tumors. Most tumors were International Federation of Gynecology and Obstetrics (FIGO) Stage I (9\/12 (75.0%)). All tumors were unilateral, and the median largest diameter was 129 (range, 38\u2013216) mm. Of the tumors, 11\/13 (84.6%) were solid and 2\/13 (15.4%) were multilocular\u2010solid; 9\/13 (69.2%) manifested abundant vascularization on color Doppler examination. Using pattern recognition, the typical ultrasound appearance was a large solid tumor with inhomogeneous echogenicity of the solid tissue and often dispersed cysts which, in most cases, were small and irregular. Some tumors had smooth contours while others had irregular contours.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A unilateral, large solid tumor with inhomogeneous echogenicity of the solid tissue and with dispersed small cystic areas in a young woman should raise the suspicion of a rare malignant germ cell tumor. This suspicion can guide the clinician to test tumor markers specific for malignant germ cell tumors. \u00a9 2020 International Society of Ultrasound in Obstetrics and Gynecology<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.23529","type":"journal-article","created":{"date-parts":[[2020,11,3]],"date-time":"2020-11-03T23:30:04Z","timestamp":1604446204000},"page":"987-994","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Imaging in gynecological disease (22): clinical\u2009and\u2009ultrasound characteristics of ovarian embryonal carcinomas, non\u2010gestational choriocarcinomas and malignant mixed germ cell tumors"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5070-7245","authenticated-orcid":false,"given":"F.","family":"Moro","sequence":"first","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna del Bambino e di Sanit\u00e0 Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. M.","family":"Castellano","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna del Bambino e di Sanit\u00e0 Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS  Rome Italy"},{"name":"Department of Obstetrics and Gynecology IRCCS San Raffaele Scientific Institute  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Franchi","sequence":"additional","affiliation":[{"name":"Preventive Gynecology Unit, Division of Gynecology European Institute of Oncology, IRCCS  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2298-7785","authenticated-orcid":false,"given":"E.","family":"Epstein","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education Karolinska Institutet and Department of Obstetrics and Gynecology, Sodersjukhuset  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7224-3218","authenticated-orcid":false,"given":"D.","family":"Fischerova","sequence":"additional","affiliation":[{"name":"Gynecological Oncology Center, Department of Obstetrics and Gynecology Charles University  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1398-9124","authenticated-orcid":false,"given":"W.","family":"Froyman","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Timmerman","sequence":"additional","affiliation":[{"name":"Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Obstetrics and Gynecology, University Hospitals Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. F.","family":"Zannoni","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna del Bambino e di Sanit\u00e0 Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS  Rome Italy"},{"name":"Dipartimento Scienze della Vita e Sanit\u00e0 Pubblica Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Scambia","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna del Bambino e di Sanit\u00e0 Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS  Rome Italy"},{"name":"Dipartimento Scienze della Vita e Sanit\u00e0 Pubblica Universit\u00e0 Cattolica del Sacro Cuore  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3830-6414","authenticated-orcid":false,"given":"L.","family":"Valentin","sequence":"additional","affiliation":[{"name":"Sk\u00e5ne University Hospital Malm\u00f6  Malm\u00f6 Sweden"},{"name":"Department of Clinical Sciences Malm\u00f6 Lund University  Malm\u00f6 Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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