Coexistence of endometriosis in women with mature cystic ovarian teratoma may not be rare.

Coexistence of endometriosis in women with mature cystic ovarian teratoma may not be rare. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Coexistence of endometriosis in women with mature cystic ovarian teratoma may not be rare. Heesuk Chae This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.2.21971/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Nov, 2020 Read the published version in Journal of Gynecology Obstetrics and Human Reproduction → Version 1 posted You are reading this latest preprint version Abstract Background We investigated the incidence of endometriosis in women with mature cystic ovarian teratoma and analyzed the clinicopathologic features of this occurrence. Methods From January 2017 through December 2018, we retrospectively studied 71 women who had undergone cystectomy for mature cystic ovarian teratoma (n = 55, teratoma group) and coexistence of endometriosis and mature cystic ovarian teratoma (n = 16, complex group). Serum anti-Müllerian hormone (AMH) levels were measured preoperatively and one month after surgery. Results Sixteen (22.54%) patients had coexistence of endometriosis and mature cystic ovarian teratoma (complex group); 55 patients had mature cystic teratoma alone (teratoma group). Early-stage endometriosis (stage I) was present in eight patients and advanced-stage endometriosis (stage III or IV) was present in eight. In five cases (31.25%), the coexistence of endometrioma and mature cystic teratoma in the same ovary was observed. The mean operation time was significantly shorter in the teratoma group than in the complex group (61.02 ± 22.74 vs. 86.31 ± 35.35 min, p = 0.007). The complex group had more dysmenorrhea (43.8% vs. 7.3%, p = 0.002) and a significantly higher rate of decrease in serum anti-Müllerian hormone (AMH) levels (33.06 ± 24.92 vs. 16.31 ± 28.17%, p = 0.048). Conclusion(s) The prevalence of coexisting endometriosis and mature cystic ovarian teratoma may be underestimated. Patients with this rare concurrence may present with worsening dysmenorrhea and damage to ovarian reserve after surgery may be greater in patients with coexisting endometriosis than in patients with mature cystic teratoma alone. Cancer Biology Sexual & Reproductive Medicine mature cystic teratoma endometriosis concomitant diseases Figures Figure 2 Background Mature cystic ovarian teratomas (MCTs) or dermoid cysts are the most common ovarian tumor in women of reproductive age and account for about 20% of ovarian tumors [ 1 , 2 ]. MCTs account for approximately 70% of benign ovarian tumors in women under 30 year of age and 50% of pediatric tumors [ 3 , 4 ]. They occur bilaterally in 10–15% of cases [ 1 ]. These tumors are usually asymptomatic and are often discovered incidentally during routine physical or during radiologic examinations [ 5 , 6 ] The proportion of asymptomatic tumors has been reported to range from 6–64.5% [ 7 , 8 , 9 , 10 ]. In addition, MCTs have a tendency to grow slowly with an estimated growth rate of 1.67 mm/year [ 1 ]. Therefore, recently, expectant management of MCTs as an alternative to surgical management has been proposed [ 1 , 3 ]. Endometriosis is a chronic inflammatory condition defined by the presence of endometrial tissue with glands and stroma outside the uterus [ 11 ]. Endometriosis is estimated to affect 10% of women in the reproductive age group [ 12 ]. The incidence of endometriosis in women with dysmenorrhea is approximately 40–60%, whereas it is up to 20–30% in women with subfertility [ 11 , 13 ]. Although MCTs and endometriosis are common gynecologic disorders occurring in women of reproductive age, concomitant MCTs and endometriosis are notably rare and have been reported in few case reports. However, the author has observed some patients with unusual concomitant MCTs and endometriosis. The aim of this study was to determine the incidence of endometriosis in patients with a diagnosis of MCT who underwent laparoscopy and to clarify further the clinical manifestations of this condition. Methods Patients All patients operated on for MCTs at the Departments of Obstetrics and Gynecology of the Chonbuk National University Hospital from January 2017 through December 2018 were included in this retrospective study. This study was approved by the Institutional Review Board of Chonbuk National University Hospital (File number: 2018-05-018-006). The requirement for obtaining informed consent from the patients was not applicable owing to the retrospective nature of the study. The inclusion criteria were as follows: (1) mature cystic ovarian teratoma confirmed by pathology and (2) endometriosis diagnosed by a pathology specimen and/or a visual confirmation of endometriosis lesions. The exclusion criteria were as follows: (1) patients with a history of previous adnexal surgery, and (2) any hormonal treatment, such as oral contraceptives, within six months prior to surgery. All patients were divided into the following groups: patients with MCTs alone (teratoma group) and patients with concomitant MCTs and endometriosis (complex group). Data regarding the patient’s age, parity, body mass index (BMI), preoperative serum cancer antigen (CA) 125 and carbohydrate antigen (CA) 19 − 9 level, hemoglobin (Hb) level, serum anti-Müllerian hormone (AMH) level, site and size of cyst, stage of endometriosis and pathology reports were retrieved from operative reports and medical records. Blood samples were preoperatively measured using radioimmunoassay for CA 125 and CA 19 − 9. The cutoff values for CA 125 and CA 19 − 9 was 35 U/mL. The Hb concentration was determined both preoperatively and 24 hours after surgery. The rate of decrease of Hb concentrations was calculated using the following formula: [(preoperative Hb concentration – postoperative Day 1 Hb concentration)/(preoperative Hb concentration)] ⅹ100(%). The serum AMH concentrations were measured preoperatively and one month after the surgery. The serum AMH level was determined using an enzyme-linked immunoassay kit, AMH Gen II (Beckman Coulter, USA). The rate of decrease of serum AMH levels was calculated using the following formula: [(preoperative serum AMH level – postoperative month 1 AMH level)/(preoperative serum AMH level)] ⅹ100(%). Cyst size was determined by preoperative imaging studies including ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). In the case of bilateral ovarian cysts, the sum of their largest diameters was defined as the cyst size. The stage of endometriosis was defined according to the revised American Fertility Society classification [ 14 ]. Statistical analysis R language ver. 3.3.3 (R Foundation for Statistical Computing, Vienna, Austria) and T&F program ver. 3.0 (YooJin BioSoft, Korea) were used for all statistical analyses. Data was expressed as mean ± standard deviation for continuous variables. The Mann-Whitney U test or Kruskal-Wallis H test were used to test the difference of continuous clinical measurements between the teratoma group and the complex group composed of ovarian endometrioma and peritoneal endometriosis. For post hoc analysis, the Bonferroni method was applied to adjust p value. For categorical variables, data was expressed as sample number and percentage, N (%), and p values were computed using the chi-squared test or Fisher’s exact test. Results A total of 71 patients were included, of whom 55 had teratoma (teratoma group) and 16 had a coexistence of endometriosis and MCTs (complex group). Table 1 presents their demographic and clinical characteristics, including serum AMH levels and surgery data. Table 1 Demographics and clinical characteristics of patients with mature cystic teratoma alone (teratoma group) and with coexisting mature cystic teratoma and endometriosis (complex group) Variable Subgroup N(%) Teratoma Complex p value Sample No (%) 71 (100) 55 (77.46) 16 (22.54) Age (years) 71 (100) 26.44 ± 6.82 27.38 ± 5.60 0.436 BMI (kg/m 2 ) 71 (100) 23.67 ± 5.81 22.74 ± 4.48 0.685 Parity (n) 71 (100) 0.758 $ 0 55 (77.5) 41 (74.5) 14 (87.5) 1 6 (8.5) 5 (9.1) 1 (6.2) 2 5 (7) 5 (9.1) 0 (0) 3 3 (4.2) 2 (3.6) 1 (6.2) 4 1 (1.4) 1 (1.8) 0 (0) 5 1 (1.4) 1 (1.8) 0 (0) CA125 (U/mL) 71 (100) 11.97 ± 7.30 19.03 ± 16.49 0.066 CA19-9 (U/mL) 71 (100) 41.88 ± 92.45 71.51 ± 121.67 0.218 Largest diameter of cyst (cm) 71 (100) 5.85 ± 3.23 7.73 ± 3.19 0.020* Laterality of cyst (n) 71 (100) 0.368 Unilateral 63 (88.7) 50 (90.9) 13 (81.2) Multilateral 8 (11.3) 5 (9.1) 3 (18.8) Locularityof cyst (n) 71 (100) 0.054 Unilocular 51 (71.8) 43 (78.2) 8 (50) Multilocular 20 (28.2) 12 (21.8) 8 (50) Preop Hb level (g/dl) 71 (100) 13.21 ± 0.90 13.14 ± 0.78 0.689 Postop Hb level (g/dl) 71 (100) 11.89 ± 0.95 11.58 ± 0.84 0.298 Decrease of Hb level (g/dl) 71 (100) 1.31 ± 0.85 1.56 ± 0.64 0.253 Rate of decrease of serum Hb levels (%) 71 (100) 9.82 ± 6.30 11.85 ± 4.69 0.186 Operation time (min) 70 (100) 61.02 ± 22.74 86.31 ± 35.35 0.007** Stage of EMS 16 (100) NA I 8 (50) 0 (0) 8 (50) III 7 (43.8) 0 (0) 7 (43.8) IV 1 (6.2) 0 (0) 1 (6.2) Preop AMH level (ng/mL) 66 (100) 5.38 ± 3.80 4.55 ± 4.08 0.209 Postop AMH level (ng/mL) 65 (100) 3.97 ± 2.52 3.01 ± 2.92 0.077 Decrease of AMH level (ng/mL) 63 (100) 0.99 ± 1.86 1.54 ± 1.82 0.180 Rate of decrease of serum AMH levels (%) 63 (100) 16.31 ± 28.17 33.06 ± 24.92 0.048* Clinical presentation (n) 71 (100) Abdominal pain 12 (16.9) 9 (16.4) 3 (18.8) > 0.99 # Dysmenorrhea 11 (15.5) 4 (7.3) 7 (43.8) 0.002 # ** Incidental finding 29 (40.8) 24 (43.6) 5 (31.2) 0.550 # Irregular vaginal bleeding 19 (26.8) 18 (32.7) 1 (6.2) 0.074 # Continuous variables are expressed as mean ± SD . Categorical variables are expressed as sample number and % . p−values for continuous variables are computed using Mann−Whitney U test (i.e. Wilcoxon rank−sum test) . p−values for categorical variables are computed using Fisher’s exact test, chi−squared test or two sample proportion test . p−value $ : computed using chi−squared test p−value # : computed using two sample proportion test N (%): computed in the total sample or subgroups excluding missing data BMI: body mass index CA 125: cancer antigen 125 CA 19−9: carbohydrate antigen 19−9 Hb : hemoglobin AMH: anti−Müllerian hormone NA: not available * p <0.05, ** p <0.01 No other parameters concerning age, parity, body mass index, laterality of cyst, and locularity of cyst differed significantly between the two groups. Serum CA 125 and CA 19 − 9 values also showed no significant differences between the two groups. The diameter of the cyst was significantly larger in the complex group than in the teratoma group (p = 0.02). The mean operation time in the teratoma group was significantly shorter with a mean of 61.02 ± 22.74 min vs. 86.31 ± 35.35 min in the complex group (p = 0.007). However, there was no significant difference in intraoperative blood loss between the two groups. The rate of decrease in serum AMH levels was significantly higher in the complex group, with a median of 33.06 ± 24.92 vs. 16.31 ± 28.17 for the teratoma group (p = 0.048). Further, a comparison of the initial clinical presentation in each group during the visit to doctor is shown in Fig. 1 . The majority of patients in the teratoma group were asymptomatic (24 cases, 43.6%) and the lesions were discovered incidentally during routine ultrasound examination, whereas the most common symptom in the complex group was dysmenorrhea (7 cases, 43.8%). Dysmenorrhea was more common in the complex group than in the teratoma group (43.8% vs. 7.3%, respectively; p = 0.002). The complex group was divided into two subgroups according to lesion type of endometriosis: ovarian endometrioma and peritoneal endometriosis. To compare further which pairs of groups were significantly different, post hoc comparison analysis was performed among the three groups: teratoma group, ovarian endometrioma subgroup, and peritoneal endometriosis subgroup (Table 2 ). Significant differences in the largest diameter of cyst (p = 0.047), operation time (p = 0.02), postoperative serum AMH level (p = 0.045) were found among the three groups. However, the post hoc comparison analysis showed that the postoperative serum AMH level alone was significantly lower in the ovarian endometrioma subgroup than in the teratoma group (p = 0.039). The difference in the rate of decrease in the serum AMH levels among the three groups was a borderline level of statistical significance (p = 0.059), but in the post-hoc comparison analysis, the differences in each subgroups were not statistically significant although the difference was the largest between the teratoma group and the ovarian endometrioma subgroup (p = 0.065). Table 2 Mean comparison analysis among teratoma group and the complex group (ovarian endometrioma and peritoneal endometriosis) Variable Teratoma (N = 55, 77.5%) Ovarian endometrioma (N = 5, 7%) Peritoneal endometriosis (N = 11, 15.5%) p value p value [1] p value [2] p value [3] Age (years) 26.44 ± 6.82 28.2 ± 5.54 27 ± 5.85 0.659 > 0.99 > 0.99 > 0.99 BMI (kg/m 2 ) 23.67 ± 5.81 24.01 ± 7.12 22.17 ± 2.94 0.885 > 0.99 > 0.99 > 0.99 CA125 (U/mL) 11.97 ± 7.3 22.08 ± 13.42 17.65 ± 18.15 0.120 0.193 0.791 > 0.99 CA19-9 (U/mL) 41.88 ± 92.45 112.77 ± 177.63 52.75 ± 91.35 0.262 0.328 > 0.99 0.856 Largest diameter of cyst (cm) 5.85 ± 3.23 8.98 ± 3.45 7.16 ± 3.06 0.047* 0.112 0.349 > 0.99 Preop Hb level (g/dl) 13.21 ± 0.9 12.56 ± 0.66 13.41 ± 0.7 0.132 0.210 > 0.99 0.147 Postop Hb level (g/dl) 11.89 ± 0.95 11.04 ± 0.76 11.83 ± 0.77 0.147 0.153 > 0.99 0.294 Decrease of Hb level (g/dl) 1.31 ± 0.85 1.52 ± 0.54 1.58 ± 0.71 0.515 > 0.99 > 0.99 > 0.99 Rate of decrease of serum Hb levels (%) 9.82 ± 6.3 12.1 ± 4.27 11.73 ± 5.06 0.388 0.821 > 0.99 > 0.99 Operation time (min) 61.02 ± 22.74 86.8 ± 22.15 86.09 ± 40.97 0.020* 0.089 0.137 > 0.99 Preop AMH level (ng/mL) 5.38 ± 3.8 2.75 ± 1.8 5.67 ± 4.79 0.167 0.176 > 0.99 0.480 Postop AMH level (ng/mL) 3.97 ± 2.52 1.48 ± 0.94 3.96 ± 3.37 0.045* 0.039* > 0.99 0.245 Decrease of AMH level (ng/mL) 0.99 ± 1.86 1.27 ± 0.93 1.71 ± 2.26 0.391 0.855 0.995 > 0.99 Rate of decrease of serum AMH levels (%) 16.31 ± 28.17 43.55 ± 15.29 26.49 ± 28.33 0.059 0.065 > 0.99 0.574 Variables are expressed as mean ± SD, and p values are computed using Kruskal−Wallis H test p−values [1] : computed between the teratoma group and the ovarian endometrioma subgroup using a post−hoc analysis algorithm of Bonferroni p−values [2] : computed between the teratoma group and the peritoneal endometriosis subgroup using a post−hoc analysis algorithm of Bonferroni p−values [3] : computed between the ovarian endometrioma subgroup and the peritoneal endometriosis subgroup using a post−hoc analysis algorithm of Bonferroni BMI: body mass index CA 125: cancer antigen 125 CA 19−9: carbohydrate antigen 19−9 Hb : hemoglobin AMH: anti−Müllerian hormone * p <0.05 The individual clinicopatholgic features of the 16 patients with coexisting MCTs and endometriosis are shown in Table 3 . In five patients, the coexistence of MCTs and ovarian endometrioma in a single ovary was observed. In case 5 and case 13, the coexistence of MCTs and ovarian endometrioma with histologic admixture in an ovarian cyst was observed, whereas in the other cases, separate teratomatous and endometrial lesions in a single ovary were observed. Further, case 2 had a combination of serous cystadenoma and teratoma, whereas, case 6 had teratoma with coincidental ovarian endometrioma and serous cystadenoma as a separate pathology. Table 3 Summary of the clinicopathologic characteristics of the 16 patients with coexistent endometriosis and mature cystic ovarian teratoma. Case no. Age (yr) CA125 (U/mL) CA19-9(U/mL) Presentation Stage Pathology 1 26 20.1 47.1 Dysmenorrhea I Teratoma, pelvic endometriosis 2 25 12.2 321.79 Dysmenorrhea I Teratoma, pelvic endometriosis, serous cystadenoma 3 26 5.8 26.44 Dysmenorrhea I Teratoma, pelvic endometriosis 4 36 70.2 71.04 Incidental findings IV Teratoma, pelvic endometriosis 5 27 19.2 52.19 Abdominal pain IV Teratoma, ovarian endometrioma 6 25 24.2 18.17 Abdominal pain III Teratoma, ovarian endometrioma, seous cystadenoma 7 29 12.9 26.44 Dysmenorrhea I Teratoma, pelvic endometriosis 8 22 17.4 12.61 Dysmenorrhea I Teratoma, pelvic endometriosis 9 38 9.2 2.69 Dysmenorrhea II Teratoma, pelvic endometriosis 10 26 19.9 3.98 Dysmenorrhea I Teratoma, pelvic endometriosis 11 19 12.3 28.94 Incidental findings I Teratoma, pelvic endometriosis 12 25 29.5 429.19 Incidental findings III Teratoma, ovarian endometrioma 13 38 1 16.8 Incidental findings III Teratoma, ovarian endometrioma 14 26 36.5 47.49 Incidental findings III Teratoma, ovarian endometrioma 15 29 8.3 24.82 Abdominal pain III Teratoma, pelvic endometriosis 16 21 5.8 14.41 Irregular vaginal bleeding I Teratoma, pelvic endometriosis CA 125: cancer antigen 125 CA 19−9: carbohydrate antigen 19−9 Discussion The present study, to the author’s knowledge, is the first attempt to investigate the incidence of the coexistence of MCTs and endometriosis and to evaluate the differential clinical characteristics of patients with this complex condition. Although MCTs and endometriosis are benign diseases that commonly affect women of reproductive age, the coexistence of MCTs and endometriosis, especially in a single ovary, is rare [ 6 , 15 , 16 ]. However, in this study, this coexistence was not rare. Although this study included a relatively small number of patients, the incidence of coexisting MCTs and endometriosis was 22.54% and its incidence in a single ovary was 7.04%. Recently, Matalliotaki et al. proposed that endometriosis is linked with an increased risk of benign gynecological tumor, such as ovarian cyst, adenomyosis and uterine leiomyomas [ 17 ]. In that study, dermoid cysts (1.5%) were observed in women with endometriosis. This data and the present study’s findings suggest that coexisting MCTs and endometriosis may be more common than previously reported. MCTs are often discovered incidentally in asymptomatic women [ 1 , 10 ]. Patients with MCTs develop symptoms such as discomfort or pain when MCTs are complicated by torsion, rupture, and infection [ 6 ]. However, various types of pain are associated with endometriosis: dysmenorrhea, deep dyspareunia, and pelvic pain unrelated to intercourse or menstruation, such as pain during defecation or urinating [ 18 ]. Sonographic examination is the initial method for identifying adnexal cystic structures, but MCTs can be occasionally difficult to distinguish from endometriomas, hemorrhagic cyst, and mucinous cystic neoplasm based on ultrasonography alone[ 19 ], and additional modalities including CT or MRI may be needed. However, the complexity and rarity of coexisting MCTs and endometriosis make it more difficult to diagnose. This study demonstrated a high prevalence of coexisting MCTs and endometriosis in those presenting with dysmenorrhea. The occurrence of dysmenorrhea was more common among women with this complex condition, whereas most MCTs occurred without clinical symptoms. The diagnosis of concomitant endometriosis in patients with MCTs rests on a high index of suspicion. Thus, gynecologic symptoms such as worsening dysmenorrhea may be a diagnostic clue. Further, in this study, the operative time was significantly shorter in patients with MCTs alone than in patients with coexisting MCTs and endometriosis. In addition, in one patient with a histologic admixture of MCTs and endometriosis in an ovarian cyst, the procedure was converted to laparotomy because of dense adhesions and a larger ovarian cyst (exceeding 10 cm in diameter). These observations indicate that concurrent endometriosis with MCTs makes surgery much more difficult. The recommended management of MCTs is generally surgical removal because of a large cyst size, risk of torsion, and concern for occult malignancy. Traditionally, MCTs have been removed by elective surgery and this procedure accounts for 20–35% of the surgical removal of ovarian tumors [ 1 , 20 ]. MCTs are the most common germ cell tumors of the ovary in women of reproductive age, and account for approximately 70% of benign ovarian neoplasms in women under 30 years of age [ 21 , 22 ]. The major concern among these younger women is future fertility. Therefore, the appropriate treatment of MCTs in children and adolescents remains unclear. A retrospective study by Hoo et al. found that the success rate of expectant management of MCTs was high and suggested that this approach be considered as a viable alternative to surgical management [ 1 ]. O’Neill et al. suggested that close follow-up without intervention should be considered to preserve ovarian function and future fertility in children and adolescents with MCTs [ 3 ]. However, endometriosis found in conjunction with MCTs makes justifying the expectant approach even more challenging. Endometriosis is a common disorder in adult women. Goldstein et al. reported a 47% prevalence of endometriosis in adolescents undergoing laparoscopy for pelvic pain [23.24]. Several studies reported a reduced number of retrieved oocytes for in vitro fertilization and premature ovarian failure after surgery for endometriosis [25.26]. The present study’s results showed that the rate of decline of serum AMH levels was significantly higher in patients with coexisting MCTs and endometriosis than in patients with MCTs alone. The study’s small sample size makes generalizing the conclusion difficult, but this result suggests that surgical cystectomy for this condition in a single ovary could cause more damage to the ovarian reserve. The malignant transformation of MCTs is an uncommon complication, with an incidence of 0.17–2% [ 3 , 4 ]. However, endometriosis is present in about 10–15% of ovarian cancers and is usually associated with endometrioid carcinoma or clear cell adenocarcinoma [ 27 ]. Moreover, Anteby et al. reported that the recurrence rate of MCTs following cystectomy was 3–4% [ 28 ]. Recurrence rates of endometrioma after surgical excision vary considerably, ranging from 6 percent through 30 percent [29.30]. Consequently, patients with coexisting MCTs and endometriosis may have an increased risk of malignancy and recurrence. Further, a collision tumor is defined as the coexistence of two adjacent, but histologically distinct tumor components [ 31 ]. Collision tumors have been reported in various organs including the esophagus, stomach, liver, bone, kidney, central nervous system and lung, and so on, but such tumors are relatively rare in the ovary [ 32 ]. In addition, the most common histologic combination of a collision tumor in the ovary is the coexistence of teratoma and mucinous tumors; therefore a combination of teratoma with serous cystadenoma is rare [ 33 ]. This study had several limitations. First, not all patients had pathology-confirmed endometriosis. Second, the reverse case–the presence of MCTs in patients with endometriosis– was not considered. In addition, the number of patients analyzed was small. Conclusions The findings of this study suggest that the coexistence of MCTs and endometriosis is not as rare as previously thought. This study also showed that among women with MCT, those with coexisting endometriosis had marked dysmenorrhea compared to women with MCT alone and that damage to ovarian reserve after cystectomy in women with coexisting endometriosis may be greater than in women with MCT alone. These results can not only help categorizing this complex disease, but can also be used to standardize its treatment. Nevertheless, further prospective studies are required to verify whether the coexistence of MCTs and endometriosis is indeed not rare. Declarations Ethics approval and consent to participate This study was approved by the Institutional Review Board of Chonbuk National University Hospital (IRB File No. 2018-05-018-006 ). Due to the retrospective design of the study an informed consent is not applicable. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding We did not receive any funding for this study. Authors’ contributions HC performed data collection, data analysis, and manuscript writing and editing. The author read and approved the final manuscript. Acknowledgements Not applicable Abbreviations BMI body mass index CA 125 cancer antigen 125 CA 19 − 9 carbohydrate antigen 19 − 9 Hb hemoglobin AMH anti-Müllerian hormone References Hoo WL, Yazbek J, Hollland T, Mavrelos D, Tong EN, Jurkovic D. Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome? Ultrasound Obstet Gynecol 2010;36:235-40. Yan L, Li M, Zhang B, Xu X, Xu Z, Han T, et al. Effect of ovarian dermoid cyst excision on ovarian reserve and response: Insights from in vitro fertilization. Gynecol Minim Invasive Ther 2016;5:161-5. O’Neill KE, Cooper AR. The approach to ovarian dermoids in adolescents and young women. J Pediatr Adolesc Gynecol 2011;24:176-80. Ayhan A, Bukulmez O, Genc D, Karamursel BS, Ayhan A. Mature cystic teratomas of the ovary: case series from one institution over 34 years. Eur J Obstet Gynecol Repro Biol. 2000;33:153-7. 5. Stany MP, Hamilton CA. Benign disorders of the ovary. Obstet Gynecol Clin North Am 2008;35:271-84. Chae H, Rheu C. Endometriosis coexisting with mature cystic teratoma in the same ovary and ectopic pregnancy of left fallopian tube: a rare coexistence. Clin Case Rep 2015;3:315-8. Kim MJ, Kim NY, Lee DY, Yoon BK, Choi D. Clinical characteristics of ovarian teratoma: age-focused retrospective analysis of 580 cases. Am J Obstet Gynecol 2011;205:32 e1-4. Peterson WF, Prevost EC, Edmunds FT, Hundley JM, Morris FK. Benign cystic teratomas of the ovary; a clinic-statistical study of 1,007 cases with a review of the literature. Am J Obstet Gynecol 1955;70:368-82. Lakkis WG, Martin MC, Gelfand MM. Benign cystic teratoma of the ovary: a 6-year review. Can J Surg 1985;28:444-6. Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol 1994;84:22-8. Selcuk I, Bozdag G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. J Turk Ger Gynecol Assoc 2013;14:98-103. Chandra A, Rho AM, Jeong K, Yu T, Jeon JH, Park SY, et al. Clinical experience of long-term use of dienogest after surgery for ovarian endometrioma. Obstet Gynecol Sci 2018;61:111-7. Farquhar C. Endometriosis. BMJ 2007;334:249-53. American Society for Reproductive: Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997;67:817-21. . van der Merwe JL, Siebert I, van Wyk AC. Rare case of perplexing ovarian endometriosis. Fertil Steril 2010;94:1910.e17-9. Caruso ML, Pirrelli M. A rare association between ovarian endometriosis and bilateral ovarian teratoma. Case report. Minerva Ginecol 1997;49:341-3. Matalliotaki C, Matalliotakis M, Ieromonachou P, Goulielmos GN, Zervou MI, Laliotis A, et al. Co-existence of benign gynecological tumors with endometriosis in a group of 1,000 women. Oncol Lett 2018;15:1529-32. Kinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol 2006;16:285-98. Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratomas of the ovary: diagnostic value of sonography. Am J Roentgenol 1998;171:1061-5. Nezhat C, Winer W, Nezhat F. Laparoscopic removal of dermoid cysts. Obstet Gynecol 1989;73:278-81. Templeman CL, Fallat ME, Lam AM, Perlman SE, Hertweck SP, O’Connor DM. Managing mature cystic teratomas of the ovary. Obstet Gynecol Surv 2000;55:738-45. Savasi I, Lacy JA, Gerstie JT, Stephens D, Kives S, Allen L. Management of ovarian dermoid cysts in the pediatric and adolescent population. J Pediatr Adolesc Gynecol 2009;22:360-4. Smorqick N, As-Sanie S, Marsh CA, Smith YR, Quint EH. Advanced stage endometriosis in adolescents and young women. J Pediatr Adolesc Gynecol 2014;27:320-3. Goldstein DP, De Cholnoky C, Emans SJ. Adolescent endometriosis. J Adolesc Health Care 1980;1:37-41. Chen Y, Pei H, Chang Y, Chen M, Wang H, Xie H, et al. The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study. J Ovarian Res 2014;7:108. Busacca M, Vignail M. Endometrioma exision and ovarian reserve: a dangerous relation. J Minim Invasive Gynecol 2009;16:142-8. Takahashi K, Kurioka H, Irikoma M, Ozaki T, Kanasaki H, Miyazaki K. Benign or malignant ovarian neoplasms and ovarian endometriomas. J Am Assoc Gynecol Laparosc 2001;8:278-84. Anteby E, Dubuisson J, Samouth N, Shimonovitz S, Ariel I, Hurwitz A. Germ cell tumors of the ovary arising after dermoid cyst resections: A long term follow-up study. Obstet Gynecol 1994;83:605-8. Busacca M, Marana R, Caruana P, Candiani M, Muzil L, Calia C, et al. Recurrence of ovarian endometrioma after laparoscopic excision. Am J Obstet Gynecol 1999;180:519-22. Sesti F, Capozzolo T, Pietropolli A, Marziali M, Bollea MR, Piccione E. Recurrence rate of endometrioma after laparoscopic cystectomy: a comparative randomized trial between post-operative hormonal suppression treatment or dietary therapy vs. placebo. Eur J Obstet Gynecol Reprod Biol 2009;147:72-7. Singh AK, Singh M. Collision tumours of ovary: a very rare case series. J Clin Diagn Res 2014;8:FD14-6. Choudhary S, Adisesha S. Collision tumors of ovary: a rare phenomenon. Int J Case Rep Imag 2012;3:68-70. Bige O, Demir A, Koyuncuoglu M, Secil M, Ulukus C, Saygili qu. Collision tumor: serous cystadenocarcinoma and dermoid cyst in the same ovary. Arch Gynecol Obstet 2009;279:767-70. Cite Share Download PDF Status: Published Journal Publication published 01 Nov, 2020 Read the published version in Journal of Gynecology Obstetrics and Human Reproduction → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-12552","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":314511,"identity":"07b4f7d6-2585-45ba-8e1a-85bdd817de64","order_by":1,"name":"Heesuk Chae","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYBACAwYGNiBlw2yAECBOSxrpWg4zEK/FnP/wswc/Ks6zm0v3GDD8qGEwNm8goMVyRpq5Yc+Z28yWc84YMPYcYzCTOUDIYTd42CR4224zG9zIMWDgbWCwkSDol/Nn2CT//jsH1sL4lygtB3LYpHkbDoC1MANtMSOs5UaambTMsWRmoKcKDssckzAmwmGHn0m+qbFLNpdI3vjwTY2N4QxCWmAgGUQcYGAgaAcC2BGvdBSMglEwCkYcAACT1DgHIyiNsgAAAABJRU5ErkJggg==","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Heesuk","middleName":"","lastName":"Chae","suffix":""}],"badges":[],"createdAt":"2020-01-24 13:27:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.2.21971/v1","doiUrl":"https://doi.org/10.21203/rs.2.21971/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1016/j.jogoh.2020.101786","type":"published","date":"2020-11-01T19:33:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":418012,"identity":"8a287b75-133a-4417-8d6c-3906087de236","added_by":"auto","created_at":"2020-01-28 16:56:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":221747,"visible":true,"origin":"","legend":"Bar plot representing sample distribution of clinical presentation between the teratoma group and the complex group. \n\nY axis presented as sample number.\nSample percentage (%) of each clinical presentation presented inside each bar.","description":"","filename":"FIgure1.png","url":"https://assets-eu.researchsquare.com/files/eaf25333-4496-4c32-9663-95b7bcf7348d/v1/FIgure 1.png"},{"id":13487030,"identity":"f783e139-a80f-4969-9ee9-bb4b5142810b","added_by":"auto","created_at":"2021-09-16 22:08:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":540199,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-12552/v1/9f081288-474d-477c-896c-e4cfd8332849.pdf"}],"financialInterests":"","formattedTitle":"Coexistence of endometriosis in women with mature cystic ovarian teratoma may not be rare.","fulltext":[{"header":"Background","content":" \u003cp\u003eMature cystic ovarian teratomas (MCTs) or dermoid cysts are the most common ovarian tumor in women of reproductive age and account for about 20% of ovarian tumors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. MCTs account for approximately 70% of benign ovarian tumors in women under 30\u0026nbsp;year of age and 50% of pediatric tumors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. They occur bilaterally in 10\u0026ndash;15% of cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These tumors are usually asymptomatic and are often discovered incidentally during routine physical or during radiologic examinations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] The proportion of asymptomatic tumors has been reported to range from 6\u0026ndash;64.5% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition, MCTs have a tendency to grow slowly with an estimated growth rate of 1.67\u0026nbsp;mm/year [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Therefore, recently, expectant management of MCTs as an alternative to surgical management has been proposed [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEndometriosis is a chronic inflammatory condition defined by the presence of endometrial tissue with glands and stroma outside the uterus [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Endometriosis is estimated to affect 10% of women in the reproductive age group [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The incidence of endometriosis in women with dysmenorrhea is approximately 40\u0026ndash;60%, whereas it is up to 20\u0026ndash;30% in women with subfertility [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough MCTs and endometriosis are common gynecologic disorders occurring in women of reproductive age, concomitant MCTs and endometriosis are notably rare and have been reported in few case reports. However, the author has observed some patients with unusual concomitant MCTs and endometriosis.\u003c/p\u003e \u003cp\u003eThe aim of this study was to determine the incidence of endometriosis in patients with a diagnosis of MCT who underwent laparoscopy and to clarify further the clinical manifestations of this condition.\u003c/p\u003e "},{"header":"Methods","content":" \u003cp\u003ePatients\u003c/p\u003e \u003cp\u003eAll patients operated on for MCTs at the Departments of Obstetrics and Gynecology of the Chonbuk National University Hospital from January 2017 through December 2018 were included in this retrospective study. This study was approved by the Institutional Review Board of Chonbuk National University Hospital (File number: 2018-05-018-006). The requirement for obtaining informed consent from the patients was not applicable owing to the retrospective nature of the study.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: (1) mature cystic ovarian teratoma confirmed by pathology and (2) endometriosis diagnosed by a pathology specimen and/or a visual confirmation of endometriosis lesions. The exclusion criteria were as follows: (1) patients with a history of previous adnexal surgery, and (2) any hormonal treatment, such as oral contraceptives, within six months prior to surgery. All patients were divided into the following groups: patients with MCTs alone (teratoma group) and patients with concomitant MCTs and endometriosis (complex group).\u003c/p\u003e \u003cp\u003eData regarding the patient\u0026rsquo;s age, parity, body mass index (BMI), preoperative serum cancer antigen (CA) 125 and carbohydrate antigen (CA) 19\u0026thinsp;\u0026minus;\u0026thinsp;9 level, hemoglobin (Hb) level, serum anti-M\u0026uuml;llerian hormone (AMH) level, site and size of cyst, stage of endometriosis and pathology reports were retrieved from operative reports and medical records. Blood samples were preoperatively measured using radioimmunoassay for CA 125 and CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9. The cutoff values for CA 125 and CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9 was 35 U/mL. The Hb concentration was determined both preoperatively and 24 hours after surgery.\u003c/p\u003e \u003cp\u003eThe rate of decrease of Hb concentrations was calculated using the following formula:\u003c/p\u003e \u003cp\u003e[(preoperative Hb concentration \u0026ndash; postoperative Day 1 Hb concentration)/(preoperative Hb concentration)] ⅹ100(%).\u003c/p\u003e \u003cp\u003eThe serum AMH concentrations were measured preoperatively and one month after the surgery. The serum AMH level was determined using an enzyme-linked immunoassay kit, AMH Gen II (Beckman Coulter, USA).\u003c/p\u003e \u003cp\u003eThe rate of decrease of serum AMH levels was calculated using the following formula:\u003c/p\u003e \u003cp\u003e[(preoperative serum AMH level \u0026ndash; postoperative month 1 AMH level)/(preoperative serum AMH level)] ⅹ100(%).\u003c/p\u003e \u003cp\u003eCyst size was determined by preoperative imaging studies including ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). In the case of bilateral ovarian cysts, the sum of their largest diameters was defined as the cyst size. The stage of endometriosis was defined according to the revised American Fertility Society classification [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003cp\u003eStatistical analysis\u003c/p\u003e \u003cp\u003eR language ver. 3.3.3 (R Foundation for Statistical Computing, Vienna, Austria) and T\u0026amp;F program ver. 3.0 (YooJin BioSoft, Korea) were used for all statistical analyses. Data was expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation for continuous variables. The Mann-Whitney U test or Kruskal-Wallis H test were used to test the difference of continuous clinical measurements between the teratoma group and the complex group composed of ovarian endometrioma and peritoneal endometriosis. For post hoc analysis, the Bonferroni method was applied to adjust p value. For categorical variables, data was expressed as sample number and percentage, N (%), and p values were computed using the chi-squared test or Fisher\u0026rsquo;s exact test.\u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":" \u003cp\u003eA total of 71 patients were included, of whom 55 had teratoma (teratoma group) and 16 had a coexistence of endometriosis and MCTs (complex group). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents their demographic and clinical characteristics, including serum AMH levels and surgery data.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eDemographics and clinical characteristics of patients with mature cystic teratoma alone (teratoma group) and with coexisting mature cystic teratoma and endometriosis (complex group)\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSubgroup\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eN(%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eComplex\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003ep value\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSample No (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e55 (77.46)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e16 (22.54)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge (years)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e26.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e27.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.60\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.436\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e23.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e22.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.685\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eParity (n)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.758\u003csup\u003e$\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e55 (77.5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e41 (74.5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e14 (87.5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6 (8.5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (9.1)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (6.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (9.1)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (4.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2 (3.6)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (6.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (1.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (1.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (1.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (1.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCA125 (U/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.97\u0026thinsp;\u0026plusmn;\u0026thinsp;7.30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e19.03\u0026thinsp;\u0026plusmn;\u0026thinsp;16.49\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.066\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCA19-9 (U/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e41.88\u0026thinsp;\u0026plusmn;\u0026thinsp;92.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e71.51\u0026thinsp;\u0026plusmn;\u0026thinsp;121.67\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.218\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLargest diameter of cyst (cm)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.020*\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLaterality of cyst (n)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.368\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnilateral\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e63 (88.7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e50 (90.9)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e13 (81.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eMultilateral\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (11.3)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (9.1)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (18.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLocularityof cyst (n)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.054\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnilocular\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e51 (71.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e43 (78.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (50)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eMultilocular\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e20 (28.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e12 (21.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (50)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePreop Hb level (g/dl)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.90\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.14\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.689\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePostop Hb level (g/dl)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.298\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDecrease of Hb level (g/dl)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.253\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRate of decrease of serum Hb levels (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.30\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.85\u0026thinsp;\u0026plusmn;\u0026thinsp;4.69\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.186\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOperation time (min)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e70 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e61.02\u0026thinsp;\u0026plusmn;\u0026thinsp;22.74\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e86.31\u0026thinsp;\u0026plusmn;\u0026thinsp;35.35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.007**\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eStage of EMS\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e16 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eNA\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (50)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e8 (50)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eIII\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (43.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (43.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eIV\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (6.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0 (0)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (6.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePreop AMH level (ng/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e66 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.80\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e4.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.08\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.209\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePostop AMH level (ng/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e65 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.01\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.077\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDecrease of AMH level (ng/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e63 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.54\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.180\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRate of decrease of serum AMH levels (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e63 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e16.31\u0026thinsp;\u0026plusmn;\u0026thinsp;28.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e33.06\u0026thinsp;\u0026plusmn;\u0026thinsp;24.92\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.048*\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eClinical presentation (n)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e71 (100)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eAbdominal pain\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12 (16.9)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e9 (16.4)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e3 (18.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003csup\u003e#\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eDysmenorrhea\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11 (15.5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e4 (7.3)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e7 (43.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.002\u003csup\u003e#\u003c/sup\u003e**\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncidental finding\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e29 (40.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e24 (43.6)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e5 (31.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.550\u003csup\u003e#\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eIrregular vaginal bleeding\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e19 (26.8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e18 (32.7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e1 (6.2)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.074\u003csup\u003e#\u003c/sup\u003e\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eContinuous variables are expressed as mean \u0026plusmn; SD\u003c/sub\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eCategorical variables are expressed as sample number and %\u003c/sub\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003ep\u0026minus;values for continuous variables are computed using Mann\u0026minus;Whitney U test (i.e. Wilcoxon rank\u0026minus;sum test)\u003c/sub\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003ep\u0026minus;values for categorical variables are computed using Fisher\u0026rsquo;s exact test, chi\u0026minus;squared test or two sample proportion test\u003c/sub\u003e.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003ep\u0026minus;value\u003c/sub\u003e\u003csup\u003e$\u003c/sup\u003e: \u003csub\u003ecomputed using chi\u0026minus;squared test\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003ep\u0026minus;value\u003c/sub\u003e\u003csup\u003e#\u003c/sup\u003e: \u003csub\u003ecomputed using two sample proportion test\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eN (%): computed in the total sample or subgroups excluding missing data\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eBMI: body mass index\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eCA 125: cancer antigen 125\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eCA 19\u0026minus;9: carbohydrate antigen 19\u0026minus;9\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eHb : hemoglobin\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eAMH: anti\u0026minus;M\u0026uuml;llerian hormone\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003eNA: not available\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csub\u003e* p \u0026lt;0.05, ** p \u0026lt;0.01\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNo other parameters concerning age, parity, body mass index, laterality of cyst, and locularity of cyst differed significantly between the two groups. Serum CA 125 and CA 19\u0026thinsp;\u0026minus;\u0026thinsp;9 values also showed no significant differences between the two groups. The diameter of the cyst was significantly larger in the complex group than in the teratoma group (p\u0026thinsp;=\u0026thinsp;0.02). The mean operation time in the teratoma group was significantly shorter with a mean of 61.02\u0026thinsp;\u0026plusmn;\u0026thinsp;22.74\u0026nbsp;min vs. 86.31\u0026thinsp;\u0026plusmn;\u0026thinsp;35.35\u0026nbsp;min in the complex group (p\u0026thinsp;=\u0026thinsp;0.007). However, there was no significant difference in intraoperative blood loss between the two groups. The rate of decrease in serum AMH levels was significantly higher in the complex group, with a median of 33.06\u0026thinsp;\u0026plusmn;\u0026thinsp;24.92 vs. 16.31\u0026thinsp;\u0026plusmn;\u0026thinsp;28.17 for the teratoma group (p\u0026thinsp;=\u0026thinsp;0.048).\u003c/p\u003e \u003cp\u003eFurther, a comparison of the initial clinical presentation in each group during the visit to doctor is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The majority of patients in the teratoma group were asymptomatic (24 cases, 43.6%) and the lesions were discovered incidentally during routine ultrasound examination, whereas the most common symptom in the complex group was dysmenorrhea (7 cases, 43.8%). Dysmenorrhea was more common in the complex group than in the teratoma group (43.8% vs. 7.3%, respectively; p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe complex group was divided into two subgroups according to lesion type of endometriosis: ovarian endometrioma and peritoneal endometriosis. To compare further which pairs of groups were significantly different, post hoc comparison analysis was performed among the three groups: teratoma group, ovarian endometrioma subgroup, and peritoneal endometriosis subgroup (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Significant differences in the largest diameter of cyst (p\u0026thinsp;=\u0026thinsp;0.047), operation time (p\u0026thinsp;=\u0026thinsp;0.02), postoperative serum AMH level (p\u0026thinsp;=\u0026thinsp;0.045) were found among the three groups. However, the post hoc comparison analysis showed that the postoperative serum AMH level alone was significantly lower in the ovarian endometrioma subgroup than in the teratoma group (p\u0026thinsp;=\u0026thinsp;0.039). The difference in the rate of decrease in the serum AMH levels among the three groups was a borderline level of statistical significance (p\u0026thinsp;=\u0026thinsp;0.059), but in the post-hoc comparison analysis, the differences in each subgroups were not statistically significant although the difference was the largest between the teratoma group and the ovarian endometrioma subgroup (p\u0026thinsp;=\u0026thinsp;0.065).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eMean comparison analysis among teratoma group and the complex group (ovarian endometrioma and peritoneal endometriosis)\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;55, 77.5%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eOvarian endometrioma\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;5, 7%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003ePeritoneal endometriosis\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(N\u0026thinsp;=\u0026thinsp;11, 15.5%)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003ep value\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003ep value \u003csup\u003e[1]\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003ep value \u003csup\u003e[2]\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003ep value \u003csup\u003e[3]\u003c/sup\u003e\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge (years)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e28.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.659\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e23.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e24.01\u0026thinsp;\u0026plusmn;\u0026thinsp;7.12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e22.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.885\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCA125 (U/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.97\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e22.08\u0026thinsp;\u0026plusmn;\u0026thinsp;13.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e17.65\u0026thinsp;\u0026plusmn;\u0026thinsp;18.15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.120\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.193\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.791\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCA19-9 (U/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e41.88\u0026thinsp;\u0026plusmn;\u0026thinsp;92.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e112.77\u0026thinsp;\u0026plusmn;\u0026thinsp;177.63\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e52.75\u0026thinsp;\u0026plusmn;\u0026thinsp;91.35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.262\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.328\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.856\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLargest diameter of cyst (cm)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.98\u0026thinsp;\u0026plusmn;\u0026thinsp;3.45\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e7.16\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.047*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.112\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.349\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePreop Hb level (g/dl)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e13.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.132\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.210\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.147\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePostop Hb level (g/dl)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.04\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.83\u0026thinsp;\u0026plusmn;\u0026thinsp;0.77\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.147\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.153\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.294\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDecrease of Hb level (g/dl)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.52\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.515\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRate of decrease of serum Hb levels (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;4.27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e11.73\u0026thinsp;\u0026plusmn;\u0026thinsp;5.06\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.388\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.821\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOperation time (min)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e61.02\u0026thinsp;\u0026plusmn;\u0026thinsp;22.74\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e86.8\u0026thinsp;\u0026plusmn;\u0026thinsp;22.15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e86.09\u0026thinsp;\u0026plusmn;\u0026thinsp;40.97\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.020*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.089\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.137\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePreop AMH level (ng/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.38\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.67\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.167\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.176\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.480\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003ePostop AMH level (ng/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.97\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.045*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.039*\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.245\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eDecrease of AMH level (ng/mL)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1.71\u0026thinsp;\u0026plusmn;\u0026thinsp;2.26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.391\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.855\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.995\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eRate of decrease of serum AMH levels (%)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e16.31\u0026thinsp;\u0026plusmn;\u0026thinsp;28.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e43.55\u0026thinsp;\u0026plusmn;\u0026thinsp;15.29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e26.49\u0026thinsp;\u0026plusmn;\u0026thinsp;28.33\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.059\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.065\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026gt;\u0026thinsp;0.99\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e0.574\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003eVariables are expressed as mean \u0026plusmn; SD, and p values are computed using Kruskal\u0026minus;Wallis H test\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003ep\u0026minus;values\u003c/sub\u003e\u003csup\u003e[1]\u003c/sup\u003e: \u003csub\u003ecomputed between the teratoma group and the ovarian endometrioma subgroup using a post\u0026minus;hoc analysis algorithm of Bonferroni\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003ep\u0026minus;values\u003c/sub\u003e\u003csup\u003e[2]\u003c/sup\u003e: \u003csub\u003ecomputed between the teratoma group and the peritoneal endometriosis subgroup using a post\u0026minus;hoc analysis algorithm of Bonferroni\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003ep\u0026minus;values\u003c/sub\u003e\u003csup\u003e[3]\u003c/sup\u003e: \u003csub\u003ecomputed between the ovarian endometrioma subgroup and the peritoneal endometriosis subgroup using a post\u0026minus;hoc analysis algorithm of Bonferroni\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003eBMI: body mass index\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003eCA 125: cancer antigen 125\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003eCA 19\u0026minus;9: carbohydrate antigen 19\u0026minus;9\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003eHb : hemoglobin\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003eAMH: anti\u0026minus;M\u0026uuml;llerian hormone\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csub\u003e* p \u0026lt;0.05\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe individual clinicopatholgic features of the 16 patients with coexisting MCTs and endometriosis are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. In five patients, the coexistence of MCTs and ovarian endometrioma in a single ovary was observed. In case 5 and case 13, the coexistence of MCTs and ovarian endometrioma with histologic admixture in an ovarian cyst was observed, whereas in the other cases, separate teratomatous and endometrial lesions in a single ovary were observed. Further, case 2 had a combination of serous cystadenoma and teratoma, whereas, case 6 had teratoma with coincidental ovarian endometrioma and serous cystadenoma as a separate pathology.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eSummary of the clinicopathologic characteristics of the 16 patients with coexistent endometriosis and mature cystic ovarian teratoma.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCase\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eno.\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eAge\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(yr)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eCA125\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(U/mL)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eCA19-9(U/mL)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003ePresentation\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eStage\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003ePathology\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e20.1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e47.1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDysmenorrhea\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e321.79\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDysmenorrhea\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis,\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eserous cystadenoma\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e26.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDysmenorrhea\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e36\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e70.2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e71.04\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncidental findings\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eIV\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e27\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e19.2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e52.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eAbdominal pain\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eIV\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, ovarian endometrioma\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e6\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e24.2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e18.17\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eAbdominal pain\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eIII\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, ovarian endometrioma,\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003eseous cystadenoma\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e7\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e26.44\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDysmenorrhea\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e22\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e17.4\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.61\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDysmenorrhea\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e9.2\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e2.69\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDysmenorrhea\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eII\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e10\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e19.9\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e3.98\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eDysmenorrhea\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e11\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e28.94\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncidental findings\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e25\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e29.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e429.19\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncidental findings\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eIII\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, ovarian endometrioma\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e13\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e38\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e16.8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncidental findings\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eIII\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, ovarian endometrioma\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e14\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e26\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e36.5\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e47.49\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eIncidental findings\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eIII\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, ovarian endometrioma\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e15\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e29\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8.3\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e24.82\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eAbdominal pain\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eIII\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e16\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003e21\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5.8\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e14.41\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eIrregular vaginal\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003ebleeding\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eI\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eTeratoma, pelvic endometriosis\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csub\u003eCA 125: cancer antigen 125\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csub\u003eCA 19\u0026minus;9: carbohydrate antigen 19\u0026minus;9\u003c/sub\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion","content":" \u003cp\u003eThe present study, to the author\u0026rsquo;s knowledge, is the first attempt to investigate the incidence of the coexistence of MCTs and endometriosis and to evaluate the differential clinical characteristics of patients with this complex condition.\u003c/p\u003e \u003cp\u003eAlthough MCTs and endometriosis are benign diseases that commonly affect women of reproductive age, the coexistence of MCTs and endometriosis, especially in a single ovary, is rare [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, in this study, this coexistence was not rare. Although this study included a relatively small number of patients, the incidence of coexisting MCTs and endometriosis was 22.54% and its incidence in a single ovary was 7.04%. Recently, Matalliotaki et al. proposed that endometriosis is linked with an increased risk of benign gynecological tumor, such as ovarian cyst, adenomyosis and uterine leiomyomas [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In that study, dermoid cysts (1.5%) were observed in women with endometriosis. This data and the present study\u0026rsquo;s findings suggest that coexisting MCTs and endometriosis may be more common than previously reported.\u003c/p\u003e \u003cp\u003eMCTs are often discovered incidentally in asymptomatic women [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Patients with MCTs develop symptoms such as discomfort or pain when MCTs are complicated by torsion, rupture, and infection [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, various types of pain are associated with endometriosis: dysmenorrhea, deep dyspareunia, and pelvic pain unrelated to intercourse or menstruation, such as pain during defecation or urinating [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Sonographic examination is the initial method for identifying adnexal cystic structures, but MCTs can be occasionally difficult to distinguish from endometriomas, hemorrhagic cyst, and mucinous cystic neoplasm based on ultrasonography alone[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and additional modalities including CT or MRI may be needed. However, the complexity and rarity of coexisting MCTs and endometriosis make it more difficult to diagnose. This study demonstrated a high prevalence of coexisting MCTs and endometriosis in those presenting with dysmenorrhea. The occurrence of dysmenorrhea was more common among women with this complex condition, whereas most MCTs occurred without clinical symptoms. The diagnosis of concomitant endometriosis in patients with MCTs rests on a high index of suspicion. Thus, gynecologic symptoms such as worsening dysmenorrhea may be a diagnostic clue.\u003c/p\u003e \u003cp\u003eFurther, in this study, the operative time was significantly shorter in patients with MCTs alone than in patients with coexisting MCTs and endometriosis. In addition, in one patient with a histologic admixture of MCTs and endometriosis in an ovarian cyst, the procedure was converted to laparotomy because of dense adhesions and a larger ovarian cyst (exceeding 10\u0026nbsp;cm in diameter). These observations indicate that concurrent endometriosis with MCTs makes surgery much more difficult.\u003c/p\u003e \u003cp\u003eThe recommended management of MCTs is generally surgical removal because of a large cyst size, risk of torsion, and concern for occult malignancy. Traditionally, MCTs have been removed by elective surgery and this procedure accounts for 20\u0026ndash;35% of the surgical removal of ovarian tumors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. MCTs are the most common germ cell tumors of the ovary in women of reproductive age, and account for approximately 70% of benign ovarian neoplasms in women under 30\u0026nbsp;years of age [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The major concern among these younger women is future fertility. Therefore, the appropriate treatment of MCTs in children and adolescents remains unclear. A retrospective study by Hoo et al. found that the success rate of expectant management of MCTs was high and suggested that this approach be considered as a viable alternative to surgical management [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. O\u0026rsquo;Neill et al. suggested that close follow-up without intervention should be considered to preserve ovarian function and future fertility in children and adolescents with MCTs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, endometriosis found in conjunction with MCTs makes justifying the expectant approach even more challenging. Endometriosis is a common disorder in adult women. Goldstein et al. reported a 47% prevalence of endometriosis in adolescents undergoing laparoscopy for pelvic pain [23.24]. Several studies reported a reduced number of retrieved oocytes for in vitro fertilization and premature ovarian failure after surgery for endometriosis [25.26]. The present study\u0026rsquo;s results showed that the rate of decline of serum AMH levels was significantly higher in patients with coexisting MCTs and endometriosis than in patients with MCTs alone. The study\u0026rsquo;s small sample size makes generalizing the conclusion difficult, but this result suggests that surgical cystectomy for this condition in a single ovary could cause more damage to the ovarian reserve.\u003c/p\u003e \u003cp\u003eThe malignant transformation of MCTs is an uncommon complication, with an incidence of 0.17\u0026ndash;2% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, endometriosis is present in about 10\u0026ndash;15% of ovarian cancers and is usually associated with endometrioid carcinoma or clear cell adenocarcinoma [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Moreover, Anteby et al. reported that the recurrence rate of MCTs following cystectomy was 3\u0026ndash;4% [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Recurrence rates of endometrioma after surgical excision vary considerably, ranging from 6 percent through 30 percent [29.30]. Consequently, patients with coexisting MCTs and endometriosis may have an increased risk of malignancy and recurrence.\u003c/p\u003e \u003cp\u003eFurther, a collision tumor is defined as the coexistence of two adjacent, but histologically distinct tumor components [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Collision tumors have been reported in various organs including the esophagus, stomach, liver, bone, kidney, central nervous system and lung, and so on, but such tumors are relatively rare in the ovary [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In addition, the most common histologic combination of a collision tumor in the ovary is the coexistence of teratoma and mucinous tumors; therefore a combination of teratoma with serous cystadenoma is rare [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study had several limitations. First, not all patients had pathology-confirmed endometriosis. Second, the reverse case\u0026ndash;the presence of MCTs in patients with endometriosis\u0026ndash; was not considered. In addition, the number of patients analyzed was small.\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003eThe findings of this study suggest that the coexistence of MCTs and endometriosis is not as rare as previously thought. This study also showed that among women with MCT, those with coexisting endometriosis had marked dysmenorrhea compared to women with MCT alone and that damage to ovarian reserve after cystectomy in women with coexisting endometriosis may be greater than in women with MCT alone. These results can not only help categorizing this complex disease, but can also be used to standardize its treatment. Nevertheless, further prospective studies are required to verify whether the coexistence of MCTs and endometriosis is indeed not rare.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of Chonbuk National University Hospital (IRB File No. 2018-05-018-006 ). Due to the retrospective design of the study an informed consent is not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe did not receive any funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHC performed data collection, data analysis, and manuscript writing and editing. The author read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n"},{"header":"Abbreviations","content":" \u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eBMI\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eCA 125\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecancer antigen 125\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eCA 19\u0026thinsp;\u0026minus;\u0026thinsp;9\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecarbohydrate antigen 19\u0026thinsp;\u0026minus;\u0026thinsp;9\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eHb\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehemoglobin\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eAMH\u003c/span\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eanti-M\u0026uuml;llerian hormone\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e "},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHoo WL, Yazbek J, Hollland T, Mavrelos D, Tong EN, Jurkovic D. Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome? Ultrasound Obstet Gynecol 2010;36:235-40.\u003c/li\u003e\n\u003cli\u003eYan L, Li M, Zhang B, Xu X, Xu Z, Han T, et al. Effect of ovarian dermoid cyst excision on ovarian reserve and response: Insights from in vitro fertilization. Gynecol Minim Invasive Ther 2016;5:161-5.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Neill KE, Cooper AR. The approach to ovarian dermoids in adolescents and young women. J Pediatr Adolesc Gynecol 2011;24:176-80.\u003c/li\u003e\n\u003cli\u003eAyhan A, Bukulmez O, Genc D, Karamursel BS, Ayhan A. Mature cystic teratomas of the ovary: case series from one institution over 34 years. Eur J Obstet Gynecol Repro Biol. 2000;33:153-7.\u003c/li\u003e\n\u003cli\u003e5. Stany MP, Hamilton CA. Benign disorders of the ovary. Obstet Gynecol Clin North Am 2008;35:271-84.\u003c/li\u003e\n\u003cli\u003eChae H, Rheu C. Endometriosis coexisting with mature cystic teratoma in the same ovary and ectopic pregnancy of left fallopian tube: a rare coexistence. Clin Case Rep 2015;3:315-8.\u003c/li\u003e\n\u003cli\u003eKim MJ, Kim NY, Lee DY, Yoon BK, Choi D. Clinical characteristics of ovarian teratoma: age-focused retrospective analysis of 580 cases. Am J Obstet Gynecol 2011;205:32 e1-4.\u003c/li\u003e\n\u003cli\u003ePeterson WF, Prevost EC, Edmunds FT, Hundley JM, Morris FK. Benign cystic teratomas of the ovary; a clinic-statistical study of 1,007 cases with a review of the literature. Am J Obstet Gynecol 1955;70:368-82.\u003c/li\u003e\n\u003cli\u003eLakkis WG, Martin MC, Gelfand MM. Benign cystic teratoma of the ovary: a 6-year review. Can J Surg 1985;28:444-6.\u003c/li\u003e\n\u003cli\u003eComerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol 1994;84:22-8.\u003c/li\u003e\n\u003cli\u003eSelcuk I, Bozdag G. Recurrence of endometriosis; risk factors, mechanisms and biomarkers; review of the literature. J Turk Ger Gynecol Assoc 2013;14:98-103.\u003c/li\u003e\n\u003cli\u003eChandra A, Rho AM, Jeong K, Yu T, Jeon JH, Park SY, et al. Clinical experience of long-term use of dienogest after surgery for ovarian endometrioma. Obstet Gynecol Sci 2018;61:111-7.\u003c/li\u003e\n\u003cli\u003eFarquhar C. Endometriosis. BMJ 2007;334:249-53.\u003c/li\u003e\n\u003cli\u003eAmerican Society for Reproductive: Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997;67:817-21. .\u003c/li\u003e\n\u003cli\u003evan der Merwe JL, Siebert I, van Wyk AC. Rare case of perplexing ovarian endometriosis. Fertil Steril 2010;94:1910.e17-9.\u003c/li\u003e\n\u003cli\u003eCaruso ML, Pirrelli M. A rare association between ovarian endometriosis and bilateral ovarian teratoma. Case report. Minerva Ginecol 1997;49:341-3.\u003c/li\u003e\n\u003cli\u003eMatalliotaki C, Matalliotakis M, Ieromonachou P, Goulielmos GN, Zervou MI, Laliotis A, et al. Co-existence of benign gynecological tumors with endometriosis in a group of 1,000 women. Oncol Lett 2018;15:1529-32.\u003c/li\u003e\n\u003cli\u003eKinkel K, Frei KA, Balleyguier C, Chapron C. Diagnosis of endometriosis with imaging: a review. Eur Radiol 2006;16:285-98.\u003c/li\u003e\n\u003cli\u003ePatel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratomas of the ovary: diagnostic value of sonography. Am J Roentgenol 1998;171:1061-5.\u003c/li\u003e\n\u003cli\u003eNezhat C, Winer W, Nezhat F. Laparoscopic removal of dermoid cysts. Obstet Gynecol 1989;73:278-81.\u003c/li\u003e\n\u003cli\u003eTempleman CL, Fallat ME, Lam AM, Perlman SE, Hertweck SP, O\u0026rsquo;Connor DM. Managing mature cystic teratomas of the ovary. Obstet Gynecol Surv 2000;55:738-45.\u003c/li\u003e\n\u003cli\u003eSavasi I, Lacy JA, Gerstie JT, Stephens D, Kives S, Allen L. Management of ovarian dermoid cysts in the pediatric and adolescent population. J Pediatr Adolesc Gynecol 2009;22:360-4.\u003c/li\u003e\n\u003cli\u003eSmorqick N, As-Sanie S, Marsh CA, Smith YR, Quint EH. Advanced stage endometriosis in adolescents and young women. J Pediatr Adolesc Gynecol 2014;27:320-3.\u003c/li\u003e\n\u003cli\u003eGoldstein DP, De Cholnoky C, Emans SJ. Adolescent endometriosis. J Adolesc Health Care 1980;1:37-41.\u003c/li\u003e\n\u003cli\u003eChen Y, Pei H, Chang Y, Chen M, Wang H, Xie H, et al. The impact of endometrioma and laparoscopic cystectomy on ovarian reserve and the exploration of related factors assessed by serum anti-Mullerian hormone: a prospective cohort study. J Ovarian Res 2014;7:108.\u003c/li\u003e\n\u003cli\u003eBusacca M, Vignail M. Endometrioma exision and ovarian reserve: a dangerous relation. J Minim Invasive Gynecol 2009;16:142-8.\u003c/li\u003e\n\u003cli\u003eTakahashi K, Kurioka H, Irikoma M, Ozaki T, Kanasaki H, Miyazaki K. Benign or malignant ovarian neoplasms and ovarian endometriomas. J Am Assoc Gynecol Laparosc 2001;8:278-84.\u003c/li\u003e\n\u003cli\u003eAnteby E, Dubuisson J, Samouth N, Shimonovitz S, Ariel I, Hurwitz A. Germ cell tumors of the ovary arising after dermoid cyst resections: A long term follow-up study. Obstet Gynecol 1994;83:605-8.\u003c/li\u003e\n\u003cli\u003eBusacca M, Marana R, Caruana P, Candiani M, Muzil L, Calia C, et al. Recurrence of ovarian endometrioma after laparoscopic excision. Am J Obstet Gynecol 1999;180:519-22.\u003c/li\u003e\n\u003cli\u003eSesti F, Capozzolo T, Pietropolli A, Marziali M, Bollea MR, Piccione E. Recurrence rate of endometrioma after laparoscopic cystectomy: a comparative randomized trial between post-operative hormonal suppression treatment or dietary therapy vs. placebo. Eur J Obstet Gynecol Reprod Biol 2009;147:72-7.\u003c/li\u003e\n\u003cli\u003eSingh AK, Singh M. Collision tumours of ovary: a very rare case series. J Clin Diagn Res 2014;8:FD14-6.\u003c/li\u003e\n\u003cli\u003eChoudhary S, Adisesha S. Collision tumors of ovary: a rare phenomenon. Int J Case Rep Imag 2012;3:68-70.\u003c/li\u003e\n\u003cli\u003eBige O, Demir A, Koyuncuoglu M, Secil M, Ulukus C, Saygili qu. Collision tumor: serous cystadenocarcinoma and dermoid cyst in the same ovary. Arch Gynecol Obstet 2009;279:767-70.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"mature cystic teratoma, endometriosis, concomitant diseases","lastPublishedDoi":"10.21203/rs.2.21971/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.2.21971/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground \u003c/p\u003e\u003cp\u003eWe investigated the incidence of endometriosis in women with mature cystic ovarian teratoma and analyzed the clinicopathologic features of this occurrence. \u003c/p\u003e\u003cp\u003eMethods \u003c/p\u003e\u003cp\u003eFrom January 2017 through December 2018, we retrospectively studied 71 women who had undergone cystectomy for mature cystic ovarian teratoma (n = 55, teratoma group) and coexistence of endometriosis and mature cystic ovarian teratoma (n = 16, complex group). Serum anti-Müllerian hormone (AMH) levels were measured preoperatively and one month after surgery. \u003c/p\u003e\u003cp\u003eResults \u003c/p\u003e\u003cp\u003eSixteen (22.54%) patients had coexistence of endometriosis and mature cystic ovarian teratoma (complex group); 55 patients had mature cystic teratoma alone (teratoma group). Early-stage endometriosis (stage I) was present in eight patients and advanced-stage endometriosis (stage III or IV) was present in eight. In five cases (31.25%), the coexistence of endometrioma and mature cystic teratoma in the same ovary was observed. The mean operation time was significantly shorter in the teratoma group than in the complex group (61.02 ± 22.74 vs. 86.31 ± 35.35 min, p = 0.007). The complex group had more dysmenorrhea (43.8% vs. 7.3%, p = 0.002) and a significantly higher rate of decrease in serum anti-Müllerian hormone (AMH) levels (33.06 ± 24.92 vs. 16.31 ± 28.17%, p = 0.048). \u003c/p\u003e\u003cp\u003eConclusion(s) \u003c/p\u003e\u003cp\u003eThe prevalence of coexisting endometriosis and mature cystic ovarian teratoma may be underestimated. Patients with this rare concurrence may present with worsening dysmenorrhea and damage to ovarian reserve after surgery may be greater in patients with coexisting endometriosis than in patients with mature cystic teratoma alone.\u003c/p\u003e","manuscriptTitle":"Coexistence of endometriosis in women with mature cystic ovarian teratoma may not be rare.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-01-28 16:56:15","doi":"10.21203/rs.2.21971/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a44439bd-3f0d-4826-b0de-829e8e8de1a0","owner":[],"postedDate":"January 28th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":53493,"name":"Cancer Biology"},{"id":53494,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2021-07-22T19:33:52+00:00","versionOfRecord":{"articleIdentity":"rs-12552","link":"https://doi.org/10.1016/j.jogoh.2020.101786","journal":{"identity":"journal-of-gynecology-obstetrics-and-human-reproduction","isVorOnly":true,"title":"Journal of Gynecology Obstetrics and Human Reproduction"},"publishedOn":"2020-11-01 19:33:52","publishedOnDateReadable":"November 1st, 2020"},"versionCreatedAt":"2020-01-28 16:56:15","video":"","vorDoi":"10.1016/j.jogoh.2020.101786","vorDoiUrl":"https://doi.org/10.1016/j.jogoh.2020.101786","workflowStages":[]},"version":"v1","identity":"rs-12552","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"identity":"rs-12552","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}