{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T19:42:52Z","timestamp":1761766972954,"version":"3.41.0"},"reference-count":72,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>We describe 21 nonpure germinomatous gonadal germ cell tumors (9 with a germinoma component), all but 1 associated with gonadoblastoma, in patients with disorders of sex development who ranged from 7 to 36 years old (average, 20\u2009y). Twenty patients were clinically described as phenotypic females with ambiguous genitalia\/virilization and primary amenorrhea. The most common documented peripheral karyotype was 46,XY (10\/12; 83%). Fifteen of 16 tumors with available clinicopathologic data were unilateral. They ranged from 7 to 30\u2009cm (mean, 15.5\u2009cm) and were solid and cystic with frequent necrosis and hemorrhage. Gonadoblastoma, in its classic (70%), dissecting (5%), or combined (25%) forms, was identified in all but 1. The malignant germ cell tumors were typically mixed except for 5 pure yolk sac tumors and 1 expansile gonadoblastoma with syncytiotrophoblast cells. When admixed, the most common component was yolk sac tumor (n=10), followed by germinoma (n=9), embryonal carcinoma (n=5), choriocarcinoma (n=4), immature teratoma (n=3), and teratoma (n=2). Typical morphologic patterns of yolk sac neoplasia, including reticular\/microcystic, solid (including blastema-like), and endodermal sinus (Schiller-Duval bodies), were seen, as well as glandular (n=10) and hepatoid (n=6) differentiation, with cystically dilated glands and diffuse hepatoid morphology in 3 and 2 tumors, respectively. Two yolk sac tumors showed a sarcomatoid pattern. Somatic-type malignancies (alveolar rhabdomyosarcoma and low-grade spindle cell sarcoma, not otherwise specified) were identified in 1 case each. This is the first large series of germ cell tumors other than typical pure germinoma associated with gonadoblastoma. The high frequency of yolk sac tumor with glandular (especially cystic glandular) and hepatoid morphologies is noteworthy, and their presence should prompt further evaluation for an associated gonadoblastoma and possible disorder of sex development.<\/jats:p>","DOI":"10.1097\/pas.0000000000001815","type":"journal-article","created":{"date-parts":[[2021,9,25]],"date-time":"2021-09-25T01:05:40Z","timestamp":1632531940000},"page":"664-676","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Malignant Gonadal Germ Cell Tumors (Other Than Pure Germinoma) in Patients With Disorders of Sex Development"],"prefix":"10.1097","volume":"46","author":[{"given":"Sheila E.","family":"Segura","sequence":"first","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert H.","family":"Young","sequence":"additional","affiliation":[{"name":"James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Oliva","sequence":"additional","affiliation":[{"name":"James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas M.","family":"Ulbright","sequence":"additional","affiliation":[{"name":"Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2021,9,23]]},"reference":[{"key":"R1-20250608","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/PAS.0000000000001625","article-title":"Malignant mixed germ cell tumors of the ovary: an analysis of 100 cases emphasizing the frequency and interrelationships of their tumor types","volume":"45","author":"Safdar","year":"2021","journal-title":"Am J Surg Pathol"},{"key":"R2-20250608","article-title":"Yolk sac tumor of the ovary: a report of 150 cases and review of the literature including historical aspects","author":"Young","year":"2021","journal-title":"Am J Surg Pathol"},{"key":"R3-20250608","doi-asserted-by":"crossref","first-page":"2355","DOI":"10.1002\/1097-0142(19821201)50:11<2355::AID-CNCR2820501122>3.0.CO;2-7","article-title":"Hepatoid yolk sac tumour of the ovary: a light microscopic, ultrastructural and immunohistochemical study of seven cases","volume":"50","author":"Prat","year":"1982","journal-title":"Cancer"},{"key":"R4-20250608","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1002\/1097-0142(195305)6:3<455::AID-CNCR2820060303>3.0.CO;2-U","article-title":"Gonadoblastoma; a gonadal tumor related to the dysgerminoma (seminoma) and capable of sex-hormone production","volume":"6","author":"Scully","year":"1953","journal-title":"Cancer"},{"key":"R5-20250608","doi-asserted-by":"crossref","first-page":"1340","DOI":"10.1002\/1097-0142(197006)25:6<1340::AID-CNCR2820250612>3.0.CO;2-N","article-title":"Gonadoblastoma\u2014review of 74 cases","volume":"25","author":"Scully","year":"1970","journal-title":"Cancer"},{"key":"R6-20250608","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.1097\/PAS.0000000000000704","article-title":"\u2018Dissecting gonadoblastoma\u2019 of Scully: a morphologic variant that often mimics germinoma","volume":"40","author":"Kao","year":"2016","journal-title":"Am J Surg Pathol"},{"key":"R9-20250608","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/01.pgp.0000250148.52215.ce","article-title":"Recent advances in the pathology and classification of gonadal neoplasms composed of germ cells and sex cord derivatives","volume":"26","author":"Talerman","year":"2007","journal-title":"Int J Gynecol Pathol"},{"key":"R10-20250608","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1687-9856-2014-4","article-title":"State of the art review in gonadal dysgenesis: challenges in diagnosis and management","volume":"1","author":"McCann-Crosby","year":"2014","journal-title":"Int J Pediatr Endocrinol"},{"key":"R11-20250608","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/his.13387","article-title":"Classical gonadoblastoma: its relationship to the \u2018dissecting\u2019 variant and undifferentiated gonadal tissue","volume":"72","author":"Roth","year":"2018","journal-title":"Histopathology"},{"key":"R12-20250608","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.humpath.2019.11.005","article-title":"Gonadoblastoma: origin and outcome","volume":"100","author":"Roth","year":"2020","journal-title":"Hum Pathol"},{"key":"R13-20250608","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/S0344-0338(80)80153-1","article-title":"The pathology of gonadal neoplasms composed of germ cells and sex cord stroma derivatives","volume":"170","author":"Talerman","year":"1980","journal-title":"Pathol Res Pract"},{"key":"R14-20250608","first-page":"2021","article-title":"Ovarian gonadoblastoma with dysgerminoma in a young girl with 46, XX karyotype: a case report","volume":"7","author":"Kanagal","year":"2013","journal-title":"J Clin Diagn Res"},{"key":"R15-20250608","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1177\/1066896917744342","article-title":"Malignant mixed germ cell tumor overgrowing a gonadoblastoma in a female with a 46, XX karyotype: a case report","volume":"26","author":"Arafah","year":"2018","journal-title":"Int J Surg Pathol"},{"key":"R16-20250608","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1097\/PGP.0000000000000551","article-title":"Classic and \u201cdissecting\u201d gonadoblastoma in a phenotypic girl with a 46, XX peripheral karyotype and no evidence of a disorder of sex development","volume":"38","author":"Roth","year":"2019","journal-title":"Int J Gynecol Pathol"},{"key":"R17-20250608","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1002\/1097-0142(197902)43:2<669::AID-CNCR2820430239>3.0.CO;2-H","article-title":"Germ cell neoplasms arising in gonadoblastomas","volume":"43","author":"Hart","year":"1979","journal-title":"Cancer"},{"key":"R18-20250608","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/0090-8258(80)90086-4","article-title":"Mixed endodermal sinus tumor of the ovary in a Swyer\u2019s syndrome patient","volume":"10","author":"Muzsnai","year":"1980","journal-title":"Gynecol Oncol"},{"key":"R19-20250608","first-page":"138","article-title":"Gonadoblastoma associated with embryonal carcinoma","volume":"43","author":"Talerman","year":"1974","journal-title":"Obstet Gynecol"},{"key":"R20-20250608","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1002\/1097-0142(195905\/06)12:3<552::AID-CNCR2820120315>3.0.CO;2-U","article-title":"Dysgenetic gonadomas and other gonadal neoplasms in intersexes; report of 5 cases and review of the literature","volume":"12","author":"Melicow","year":"1959","journal-title":"Cancer"},{"key":"R21-20250608","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1002\/1097-0142(196708)20:8<1301::AID-CNCR2820200814>3.0.CO;2-4","article-title":"Occurrence of tumors in dysgenetic gonads","volume":"20","author":"Teter","year":"1967","journal-title":"Cancer"},{"key":"R22-20250608","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1006\/gyno.1993.1201","article-title":"Five different histological subtypes of germ cell malignancies in an XY female","volume":"50","author":"Bremer","year":"1993","journal-title":"Gynecol Oncol"},{"key":"R23-20250608","first-page":"847","article-title":"Rhabdomyosarcoma. A new classification scheme related to prognosis","volume":"116","author":"Tsokos","year":"1992","journal-title":"Arch Pathol Lab Med"},{"key":"R24-20250608","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1542\/peds.2006-0738","article-title":"Consensus statement on management of intersex disorders International Consensus Conference on Intersex","volume":"118","author":"Lee","year":"2006","journal-title":"Pediatrics"},{"key":"R27-20250608","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1111\/j.1471-0528.2008.01703.x","article-title":"Swyer syndrome: presentation and outcomes","volume":"115","author":"Michala","year":"2008","journal-title":"BJOG"},{"key":"R28-20250608","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1210\/er.2006-0005","article-title":"Germ cell tumors in the intersex gonad: old paths, new directions, moving frontiers","volume":"27","author":"Cools","year":"2006","journal-title":"Endocr Rev"},{"key":"R29-20250608","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1006\/gyno.1994.1324","article-title":"Endodermal sinus tumor arising from a dysgenetic gonad in a 46,XX female combined with m\u00fcllerian agenesis","volume":"55","author":"Nam","year":"1994","journal-title":"Gynecol Oncol"},{"key":"R30-20250608","first-page":"66","article-title":"Gonadoblastoma overgrown by dysgerminoma in women with 46,XX karyotype","volume":"37","author":"Kim","year":"2003","journal-title":"Korean J Pathol"},{"key":"R31-20250608","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s00404-011-2073-9","article-title":"Ovarian gonadoblastoma with dysgerminoma in a 15-year-old girl with 46, XX karyotype: case report and review of the literature","volume":"285","author":"Esin","year":"2012","journal-title":"Arch Gynecol Obstet"},{"key":"R32-20250608","first-page":"e8990","article-title":"Bilateral gonadoblastoma with dysgerminoma in a phenotypically normal female with 46xx karyotype: report of a rare case and literature review","volume":"3","author":"Raafey","year":"2020","journal-title":"Cureus"},{"key":"R33-20250608","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1002\/dc.24282","article-title":"Usefulness of imprint cytology of gonadoblastoma with dysgerminoma in a patient with Turner syndrome and a Y chromosome: a case report and literature review","volume":"47","author":"Nagai","year":"2019","journal-title":"Diagn Cytopathol"},{"key":"R34-20250608","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/S0022-5347(17)59480-X","article-title":"Gonadoblastoma associated with embryonal carcinoma in an anatomically normal man","volume":"113","author":"Talerman","year":"1975","journal-title":"J Urol"},{"key":"R35-20250608","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1097\/PAS.0000000000001687","article-title":"Dysgerminoma of the ovary: an analysis of 140 cases emphasizing unusual microscopic findings and resultant diagnostic problems","volume":"45","author":"Warnnissorn","year":"2021","journal-title":"Am J Surg Pathol"},{"key":"R36-20250608","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s00428-005-1272-9","article-title":"Gonadoblastoma: evidence for a stepwise progression to dysgerminoma in a dysgenetic ovary","volume":"447","author":"Pauls","year":"2005","journal-title":"Virchows Arch"},{"key":"R37-20250608","doi-asserted-by":"crossref","first-page":"5017","DOI":"10.3390\/ijms20205017","article-title":"Predicting gonadal germ cell cancer in people with disorders of sex development; insights from developmental biology","volume":"20","author":"Looijenga","year":"2019","journal-title":"Int J Mol Sci"},{"key":"R38-20250608","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1016\/j.beem.2007.05.001","article-title":"Tumor risk in disorders of sex development (DSD)","volume":"21","author":"Looijenga","year":"2007","journal-title":"Best Pract Res Clin Endocrinol Metab"},{"key":"R39-20250608","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1002\/ajmg.c.31562","article-title":"A practical guide for evaluating gonadal germ cell tumor predisposition in differences of sex development","volume":"175","author":"Pyle","year":"2017","journal-title":"Am J Med Genet C Semin Med Genet"},{"key":"R40-20250608","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.humpath.2005.02.016","article-title":"Identification of germ cells at risk for neoplastic transformation in gonadoblastoma: an immunohistochemical study for OCT3\/4 and TSPY","volume":"36","author":"Kersemaekers","year":"2005","journal-title":"Hum Pathol"},{"key":"R41-20250608","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/00000478-198603000-00001","article-title":"Yolk sac differentiation in germ cell tumors. A morphologic study of 50 cases with emphasis on hepatic, enteric, and parietal yolk sac features","volume":"10","author":"Ulbright","year":"1986","journal-title":"Am J Surg Pathol"},{"key":"R42-20250608","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1046\/j.1365-2559.1999.00650.x","article-title":"Ovarian hepatoid yolk sac tumours: morphological, immunohistochemical and ultrastructural features","volume":"34","author":"Devouassoux-Shisheboran","year":"1999","journal-title":"Histopathology"},{"key":"R43-20250608","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1097\/00000478-198709000-00004","article-title":"The frequency and histology of hepatic tissue in germ cell tumors","volume":"11","author":"Nakashima","year":"1987","journal-title":"Am J Surg Pathol"},{"issue":"suppl 2","key":"R44-20250608","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1016\/S0893-3952(22)04459-3","article-title":"Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues","volume":"18","author":"Ulbright","year":"2005","journal-title":"Mod Pathol"},{"key":"R45-20250608","doi-asserted-by":"crossref","first-page":"2775","DOI":"10.1002\/1097-0142(19871201)60:11<2775::AID-CNCR2820601130>3.0.CO;2-S","article-title":"Hepatoid carcinoma of the ovary. A newly described tumor","volume":"60","author":"Ishikura","year":"1987","journal-title":"Cancer"},{"key":"R46-20250608","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/01.PGP.0000055173.04957.66","article-title":"Hepatoid carcinoma of the ovary: a report of three cases admixed with a common surface epithelial carcinoma","volume":"22","author":"Tochigi","year":"2003","journal-title":"Int J Gynecol Pathol"},{"key":"R47-20250608","first-page":"341","article-title":"Hepatoid carcinoma of the ovary. A case report and review of the literature","volume":"30","author":"Zizi-Sermpetzoglou","year":"2009","journal-title":"Eur J Gynaecol Oncol"},{"key":"R48-20250608","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1007\/s00404-009-1259-x","article-title":"Hepatoid carcinoma of the ovary with sex cord stromal tumor: a previously unrecognized association","volume":"281","author":"D\u2019Antonio","year":"2010","journal-title":"Arch Gynecol Obstet"},{"key":"R49-20250608","doi-asserted-by":"crossref","first-page":"e20051","DOI":"10.1097\/MD.0000000000020051","article-title":"Primary hepatoid carcinoma of the ovary: a case report and review of the literature","volume":"99","author":"Choi","year":"2020","journal-title":"Medicine"},{"key":"R50-20250608","doi-asserted-by":"crossref","first-page":"100564","DOI":"10.1016\/j.gore.2020.100564","article-title":"Hepatoid carcinoma of the ovary\u2014a case report and literature review","volume":"1","author":"Uribe Rivera","year":"2020","journal-title":"Gynecol Oncol Rep"},{"key":"R51-20250608","doi-asserted-by":"crossref","first-page":"543","DOI":"10.5009\/gnl.2011.5.4.543","article-title":"Metastasis of hepatocellular carcinoma to the ovary: a case report and review of the literature","volume":"5","author":"Lee","year":"2011","journal-title":"Gut Liver"},{"key":"R53-20250608","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/PAS.0000000000001588","article-title":"Hepatoid teratoma, hepatoid yolk sac tumor, and hepatocellular carcinoma: a morphologic and immunohistochemical study of 30 cases","volume":"45","author":"Al-Obaidy","year":"2021","journal-title":"Am J Surg Pathol"},{"key":"R54-20250608","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1111\/j.1365-2559.2011.03889.x","article-title":"Yolk sac tumours revisited. A review of their many faces and names","volume":"60","author":"Nogales","year":"2012","journal-title":"Histopathology"},{"key":"R55-20250608","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/PGP.0000000000000134","article-title":"Gonadoblastoma and hepatoid and endometrioid-like yolk sac tumor: an update","volume":"33","author":"Ulbright","year":"2014","journal-title":"Int J Gynecol Pathol"},{"key":"R57-20250608","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1097\/PAS.0b013e318033c7c4","article-title":"Germ cell tumors with sarcomatous components: a clinicopathologic and immunohistochemical study of 46 cases","volume":"31","author":"Malag\u00f3n","year":"2007","journal-title":"Am J Surg Pathol"},{"key":"R58-20250608","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1002\/1097-0142(197907)44:1<281::AID-CNCR2820440148>3.0.CO;2-B","article-title":"Rhabdomyosarcoma arising in pineal teratoma","volume":"44","author":"Preissing","year":"1979","journal-title":"Cancer"},{"key":"R59-20250608","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1002\/mpo.2950230609","article-title":"Embryonal rhabdomyosarcoma arising in a germ cell tumour","volume":"23","author":"Corbett","year":"1994","journal-title":"Med Pediatr Oncol"},{"key":"R60-20250608","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/S0022-5347(01)64035-7","article-title":"Teratoma with malignant transformation: diverse malignant histologies arising in men with germ cell tumors","volume":"159","author":"Motzer","year":"1998","journal-title":"J Urol"},{"key":"R61-20250608","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.1002\/1097-0142(19841101)54:9<1824::AID-CNCR2820540910>3.0.CO;2-J","article-title":"The development of non-germ cell malignancies within germ cell tumors. A clinicopathologic study of 11 cases","volume":"54","author":"Ulbright","year":"1984","journal-title":"Cancer"},{"key":"R62-20250608","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/1097-0142(19900101)65:1<148::AID-CNCR2820650129>3.0.CO;2-V","article-title":"Spindle cell tumors resected from male patients with germ cell tumors. A clinicopathologic study of 14 cases","volume":"65","author":"Ulbright","year":"1990","journal-title":"Cancer"},{"key":"R63-20250608","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/00000478-198610000-00007","article-title":"The occurrence of sarcomatous components in primary mediastinal germ cell tumors","volume":"10","author":"Manivel","year":"1986","journal-title":"Am J Surg Pathol"},{"key":"R64-20250608","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1002\/1097-0142(19841101)54:9<2015::AID-CNCR2820540939>3.0.CO;2-B","article-title":"Sarcoma arising in a residual testicular teratoma after cytoreductive chemotherapy","volume":"54","author":"Ahlgren","year":"1984","journal-title":"Cancer"},{"key":"R65-20250608","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/BF00185674","article-title":"Unusual neoplasms detected in testicular cancer patients undergoing postchemotherapy retroperitoneal lymphadenectomy","volume":"12","author":"Little","year":"1994","journal-title":"World J Urol"},{"key":"R66-20250608","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1097\/00000478-200002000-00012","article-title":"The pathology of late recurrence of testicular germ cell tumors","volume":"24","author":"Michael","year":"2000","journal-title":"Am J Surg Pathol"},{"key":"R67-20250608","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1093\/ajcp\/94.1.89","article-title":"Spermatocytic seminoma associated with rhabdomyosarcoma","volume":"94","author":"Matoska","year":"1990","journal-title":"Am J Clin Pathol"},{"key":"R68-20250608","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/00000478-198802000-00001","article-title":"Spermatocytic seminoma of testis with sarcomatous transformation. A report of five cases","volume":"12","author":"True","year":"1988","journal-title":"Am J Surg Pathol"},{"key":"R69-20250608","doi-asserted-by":"crossref","first-page":"2404","DOI":"10.1210\/jc.2005-2554","article-title":"Gonadoblastoma arising in undifferentiated gonadal tissue within dysgenetic gonads","volume":"91","author":"Cools","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"R70-20250608","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.jpag.2019.06.005","article-title":"A management protocol for gonad preservation in patients with androgen insensitivity syndrome","volume":"32","author":"Weidler","year":"2019","journal-title":"J Pediatr Adolesc Gynecol"},{"key":"R71-20250608","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/0002-9378(76)90160-5","article-title":"The age of occurrence of gonadal tumors in intersex patients with a Y chromosome","volume":"124","author":"Manuel","year":"1976","journal-title":"Am J Obstet Gynecol"},{"key":"R72-20250608","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/0165-4608(87)90180-4","article-title":"Abnormal sexual differentiation and neoplasia","volume":"25","author":"Verp","year":"1987","journal-title":"Cancer Genet Cytogenet"},{"issue":"suppl","key":"R73-20250608","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1016\/j.juro.2008.03.110","article-title":"Complete androgen insensitivity: the role of the surgeon","volume":"180","author":"Purves","year":"2008","journal-title":"J Urol"},{"key":"R74-20250608","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/path.1890","article-title":"Testicular development in the complete androgen insensitivity syndrome","volume":"208","author":"Hannema","year":"2006","journal-title":"J Pathol"},{"key":"R75-20250608","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1159\/000477921","article-title":"Update on the pathophysiology and risk factors for the development of malignant testicular germ cell tumors in complete androgen insensitivity syndrome","volume":"11","author":"Cools","year":"2017","journal-title":"Sex Dev"},{"key":"R76-20250608","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/00004347-199104000-00002","article-title":"The androgen insensitivity syndrome (testicular feminization): a clinicopathologic study of 43 cases","volume":"10","author":"Rutgers","year":"1991","journal-title":"Int J Gynecol Pathol"},{"key":"R77-20250608","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1097\/01.pas.0000173027.25594.60","article-title":"The frequency and distribution of intratubular trophoblast in association with germ cell tumors of the testis","volume":"29","author":"Berney","year":"2005","journal-title":"Am J Surg Pathol"},{"key":"R78-20250608","doi-asserted-by":"crossref","DOI":"10.1002\/pbc.26913","article-title":"Gonadal dysgenesis is associated with worse outcomes in patients with ovarian nondysgerminomatous tumors: a report of the Children\u2019s Oncology Group AGCT 0132 Study","author":"Dicken","year":"2018","journal-title":"Pediatr Blood Cancer"}],"container-title":["American Journal of Surgical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PAS.0000000000001815","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T21:03:27Z","timestamp":1749416607000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PAS.0000000000001815"}},"subtitle":["A Report of 21 Cases Based Largely on the Collection of Dr Robert E. Scully, Illustrating a High Frequency of Yolk Sac Tumor With Prominent Hepatoid and Glandular Features"],"short-title":[],"issued":{"date-parts":[[2021,9,23]]},"references-count":72,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1097\/pas.0000000000001815","relation":{},"ISSN":["0147-5185"],"issn-type":[{"type":"print","value":"0147-5185"}],"subject":[],"published":{"date-parts":[[2021,9,23]]}}}