Volume 154, Issue 2, Pages (August 2019)

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Volume 154, Issue 2, Pages 259-265 (August 2019) Recurrent ovarian immature teratoma in a 12-year-old girl: Implications for management Jenny L. Frazer, C. Elizabeth Hook, Helen C. Addley, Claire R. Jackson, John A. Latimer, James C. Nicholson, Matthew J. Murray Gynecologic Oncology Volume 154, Issue 2, Pages 259-265 (August 2019) DOI: 10.1016/j.ygyno.2019.05.032 Copyright © 2019 Elsevier Inc. Terms and Conditions

Fig. 1 Longitudinal serum AFP estimations for the ovarian immature teratoma case. Interventions (boxes) are shown at the specific timepoints indicated by the red arrows. Key: d = day; GTS = growing teratoma syndrome; # = chemotherapy course. Gynecologic Oncology 2019 154, 259-265DOI: (10.1016/j.ygyno.2019.05.032) Copyright © 2019 Elsevier Inc. Terms and Conditions

Fig. 2 Radiological imaging for the ovarian immature teratoma case. A) Coronal T2 weighted MR image at diagnosis demonstrating a large cystic lesion arising from the right ovary occupying the entire abdomen and pelvis with complex solid contents (arrow); B) axial T1 weighted MR image demonstrating areas of high signal intensity (arrow) in keeping with small areas of fat; C) axial T2 weighted MR image five months following right salpingo-oophorectomy showing a complex mass (arrow) posterior to the uterus (*) consistent with first recurrent disease; D) axial T2 weighted MR image two months following surgical resection of pelvic recurrence demonstrating a complex mass in the right adnexa (arrow) adjacent to the uterus (*) in keeping with second recurrent disease; E) axial T2 weighted MR image at the same examination as in D) demonstrating a new liver lesion (arrow) confirming metastatic disease; and F) Axial T2 weighted MR image of the pelvis following two cycles of chemotherapy revealing an increase in size of the lesion (arrow) posterior to the uterus (*). Gynecologic Oncology 2019 154, 259-265DOI: (10.1016/j.ygyno.2019.05.032) Copyright © 2019 Elsevier Inc. Terms and Conditions

Fig. 3 Histopathologic appearances of the resection specimens. A) Primary ovarian resection specimen showing focus of immature neuroepithelium (arrow) with surrounding mature elements (×40); B) resection specimen from first recurrence showing extensive immature neuroepithelium throughout image (×40); C) ‘microfoci’ of yolk sac tumor (arrow) at first recurrence (×400); D) and E) AFP and glypican-3 staining (arrows), respectively, of the same focus as in C) (×400); and F) hepatic resection specimen of second recurrence post-chemotherapy, showing deposit of mature teratoma (left) with native liver present (right) (×40). Gynecologic Oncology 2019 154, 259-265DOI: (10.1016/j.ygyno.2019.05.032) Copyright © 2019 Elsevier Inc. Terms and Conditions