{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:26:28Z","timestamp":1791865588761,"version":"4.3.4"},"reference-count":64,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe the clinical and ultrasound characteristics of ovarian mature cystic teratoma containing malignancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an international, retrospective, observational study. We invited 19 (oncological or non\u2010oncological) gynecological centers to provide clinical and ultrasound information on cases of histologically confirmed ovarian mature cystic teratoma containing malignancy. We reported the description of the tumors by the original ultrasound examiner by extracting information from original ultrasound reports and patient records. In addition, two gynecologists, who were European Federation of Societies for Ultrasound in Medicine and Biology Level\u2009II or III in gynecological ultrasound, reviewed all available electronic ultrasound images and used pattern recognition with the aim of identifying the typical sonographic features of ovarian mature cystic teratomas containing malignancy. International Ovarian Tumor Analysis terminology was used to describe the tumors throughout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 10\/19 invited centers, no eligible patients were identified. From the databases of nine gynecological centers (three of which were oncological centers), we identified 26 patients with a histologically confirmed malignancy in an ovarian mature cystic teratoma who had undergone preoperative ultrasound examination between September 2012 and August 2024. The median age of the 26 included patients was 48.5 (range, 14\u201379)\u2009years and most (17\/26 (65.4%)) were postmenopausal. The most frequent malignant histology was squamous cell carcinoma (13\/26 (50.0%)), followed by carcinoid tumor and mucinous malignancy (each 5\/26 (19.2%)), endometrioid carcinoma (2\/26 (7.7%)) and ganglioglioma (1\/26 (3.8%)). Based on the information in the original ultrasound reports, all lesions were unilateral. The median maximum diameter of the ovarian tumors was 110 (range, 21\u2013310)\u2009mm. Teratomas containing a mucinous malignancy were the largest (median maximum diameter, 210 (range, 120\u2013310)\u2009mm) and teratomas containing a carcinoid tumor were the smallest (median maximum diameter, 29 (range, 21\u201364)\u2009mm). Most tumors containing squamous cell carcinoma, carcinoid tumor, endometrioid cancer or ganglioglioma were described as a unilocular cyst (9\/21 (42.9%)) or unilocular\u2010solid cyst (6\/21 (28.6%)) by the original ultrasound examiner and most (16\/21 (76.2%)) were described as containing cystic content of mixed echogenicity (i.e. the echogenicity typical of a mature cystic teratoma). All five teratomas containing mucinous malignancies were described as a multilocular or multilocular\u2010solid cyst and most (4\/5 (80.0%)) were described as containing cystic fluid of low\u2010level or ground\u2010glass echogenicity. Acoustic shadows were described in 14\/26 (53.8%) tumors. Eleven of the 26 (42.3%) tumors had moderate or rich vascularization on color Doppler (color score of 3 or 4). The original ultrasound examiner misclassified 12\/26 (46.2%) tumors as a benign teratoma. Good\u2010quality ultrasound images were available for 25 tumors. On retrospective review of the ultrasound images using pattern recognition, 10\/25 (40.0%) tumors appeared as a typical mature cystic teratoma, 8\/25 (32.0%) showed features typical of a mature cystic teratoma but contained a solid component (7\/8) or multiple cyst locules (1\/8), making them suspicious for malignancy, and 7\/25 (28.0%) lacked characteristics typical of a mature cystic teratoma and appeared malignant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>40.0% of the mature cystic teratomas containing malignancy in our series appeared sonographically indistinguishable from benign teratomas. The presence of solid components within the tumor, especially if vascularized on color or power Doppler, large tumor size, advanced age and postmenopausal status raised the ultrasound examiner's suspicion of malignancy. Serum CA\u2009125 level appears to have a limited role as a risk factor for malignancy, as it is not elevated in most reported cases of squamous cell carcinoma arising in mature cystic teratomas. In contrast, squamous cell carcinoma antigen levels may be more useful. \u00a9 2026 International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70224","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T13:31:31Z","timestamp":1778506291000},"page":"852-863","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Imaging in gynecological disease (31): clinical and ultrasound characteristics of ovarian mature cystic teratomas containing malignancies"],"prefix":"10.1002","volume":"67","author":[{"given":"M. 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F.","family":"Zannoni","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"},{"name":"Department of Life Sciences and Public Health Catholic University of the Sacred Heart  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Scaglione","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"}],"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 Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3707-6645","authenticated-orcid":false,"given":"D.","family":"Timmerman","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University Hospitals Leuven  Leuven Belgium"},{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1421-6059","authenticated-orcid":false,"given":"T.","family":"Bourne","sequence":"additional","affiliation":[{"name":"Department of Metabolism, Digestion &amp; Reproduction, Faculty of Medicine Imperial College London  London UK"},{"name":"Queen Charlotte's and Chelsea Hospital Imperial College London  London UK"},{"name":"Department of Development and Regeneration KU Leuven  Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Fagotti","sequence":"additional","affiliation":[{"name":"Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario Agostino Gemelli IRCCS  Rome Italy"},{"name":"Department of Life Sciences and Public Health Catholic University of the Sacred Heart  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":"Department of Obstetrics and Gynecology Sk\u00e5ne University Hospital  Malm\u00f6 Sweden"},{"name":"Department of Clinical Sciences Malm\u00f6 Lund University  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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