in the category of germ cell tumors, the most common one is Yolk sac tumor, but then there'll be some embryonals. There'll be some dysterminoas. There'll be a lot of mixed tumors where you might have yolk sac with mature teratoma, yolk sac with immature teratoma
quite frankly, a week is not going to make any difference to her oncologically. So if you did torse it. Give her some time to calm down, reimage it, get, get some good imaging when this is resolved, see what it looks like, check the markers, and then go back in
I think there's very good data that if it's predominantly cystic, probably the chance of malignancy is probably 3% or 4%. If it's kind of more heterogeneous, the malignancy rate might be more like 15% to 20%. And if it's solid, it's probably over 25% at least.
I think one interesting thing I saw a few years ago in one of Dr. Deborah Billmar's papers was a group of stage 3 ovarian tumors. I think there were 20 of them. Five of them were stage 3 only because their peritoneal fluid was positive for malignant cells.
if it's predominantly cystic. Probably the chance of malignancy is probably 3 or 4%. If it's kind of a more heterogeneous, the malignancy rate might be more like 15 to 20%, and if it's solid, it's probably over 25% at least
I think it's also something where it's very important for us as pediatric surgeons to emphasize ovarian preservation. When we see things like torsion or tumors, since so many are benign, we often can preserve the ovarian.
quoteI think ovarian is a great topic. One, it's pretty common. And I think most of us as pediatric surgeons see a lot of ovarian tumors. We see more of them than we see of like Wilms neuroblastoma or other types of tumors, even though among the ovarian tumors, most of them are not malignant.↗
▶Ep 2 · 2:25
quoteI think it's also something where it's very important for us as pediatric surgeons to emphasize ovarian preservation. When we see things like torsion or tumors, since so many are benign, we often can preserve the ovarian.↗
▶Ep 2 · 2:45
quoteThere's evidence that we're doing better at that. But there's also some evidence that there are a lot of tumors that have been taken out in the last 20 years where we probably could have, in retrospect, preserved some functional ovary and not done a complete oophorectomy.↗
▶Ep 2 · 3:25
clinicalAlpha-fetoprotein (AFP) is the primary tumor marker for pediatric ovarian tumors; HCG is unlikely to be elevated in young children but is checked routinely↗
▶Ep 2 · 3:55
quoteI think when you look at the child, you know, one thing we're always trying to determine is, what is the risk of malignancy from the imaging?↗
▶Ep 2 · 4:03
epidemiologicalPredominantly cystic ovarian masses have approximately 3-4% malignancy risk↗
▶Ep 2 · 4:03
quoteI think there's very good data that if it's predominantly cystic, probably the chance of malignancy is probably 3% or 4%. If it's kind of more heterogeneous, the malignancy rate might be more like 15% to 20%. And if it's solid, it's probably over 25% at least.↗
▶Ep 2 · 4:25
epidemiologicalHeterogeneous ovarian masses have 15-20% malignancy rate↗
▶Ep 2 · 4:32
epidemiologicalSolid ovarian masses have over 25% malignancy risk↗
▶Ep 2 · 4:38
quoteI think it emphasized that when we do take her to the operating, we have to sort of try to preserve the principles of an oncologic operation.↗
▶Ep 2 · 5:03
epidemiologicalApproximately 10% or less of all pediatric ovarian tumors are malignant↗
▶Ep 2 · 5:18
epidemiologicalAmong malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series↗
▶Ep 2 · 5:43
epidemiologicalAmong benign pediatric ovarian tumors, mature teratoma comprises at least half of cases↗
▶Ep 2 · 5:51
epidemiologicalImmature teratoma accounts for approximately 10-15% of benign ovarian tumors↗
▶Ep 2 · 8:10
quoteI think one interesting thing I saw a few years ago in one of Dr. Deborah Billmar's papers was a group of stage 3 ovarian tumors. I think there were 20 of them. Five of them were stage 3 only because their peritoneal fluid was positive for malignant cells.↗
▶Ep 2 · 8:10
clinicalIn a study of 20 stage III ovarian tumors, 5 were stage III only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage I with likely higher recurrence↗
▶Ep 2 · 8:35
quoteI really, you know, these are pretty simple tests. They're not very hard to do. They don't hurt the child. It just takes a few extra minutes for us in there. I think it's a good principle to have kind of the standard operation in your mind all the time and for the most part to do that.↗
▶Ep 2 · 10:40
guidelineFor ovarian tumor surgery, six oncologic steps are recommended: peritoneal washings, tumor removal, contralateral ovary inspection (biopsy only if abnormal), omental assessment (remove if adherent to tumor), peritoneal cavity assessment for implants, and retroperitoneal lymph node palpation (remove only if enlarged)↗
▶Ep 2 · 10:54
guidelineContralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely↗
▶Ep 2 · 15:57
epidemiologicalFor large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1%↗
▶Ep 2 · 20:53
guidelineChest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively↗
▶Ep 2 · 21:31
clinicalFor malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present↗
▶Ep 2 · 21:42
clinicalFallopian tube preservation during oophorectomy is optional; the tube should be preserved if not encased by tumor but can be removed if adherent or difficult to separate↗
▶Ep 2 · 22:48
clinicalPeritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage↗
▶Ep 2 · 23:20
clinicalPediatric surgeons manage primarily germ cell tumors (chemo-responsive) while gynecologic oncologists manage primarily epithelial tumors, explaining differences in surgical approach including lymph node dissection↗
▶Ep 2 · 24:07
guidelineOmental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation↗
▶Ep 2 · 24:16
clinicalRadiation therapy has no role in treatment of pediatric germ cell ovarian tumors↗
▶Ep 2 · 24:32
opinionOvarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy↗
▶Ep 2 · 26:57
epidemiologicalPre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents↗
▶Ep 2 · 26:57
clinicalFor acute ovarian torsion with unclear mass characteristics, detorsion can be performed and the ovary left in place with delayed resection after obtaining markers and better imaging↗
▶Ep 2 · 27:12
guidelineOophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary↗
▶Ep 2 · 28:50
clinicalA one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery↗
▶Ep 2 · 30:20
epidemiologicalStage I malignant germ cell ovarian tumors have 96% overall survival↗
▶Ep 2 · 30:33
epidemiologicalStage I germ cell tumors managed with observation alone have approximately 50% relapse rate↗
▶Ep 2 · 30:43
epidemiologicalSalvage rate for relapsed stage I germ cell tumors is nearly 100%↗
▶Ep 2 · 30:55
epidemiologicalStage II and III germ cell ovarian tumors have 97% survival with chemotherapy↗
▶Ep 2 · 31:15
epidemiologicalStage IV germ cell ovarian tumors have approximately 80% overall survival↗
▶Ep 2 · 31:23
epidemiologicalStage IV germ cell tumors in patients under 11 years have 92% survival↗
▶Ep 2 · 31:33
epidemiologicalStage IV germ cell tumors in patients over 11 years have 60% survival↗
▶Ep 2 · 31:40
quoteI think if you're over 11 and have a stage four tumor, you're high risk. If you're under 11 and you have a stage four tumor, or if you have stage two or three, you're kind of intermediate risk.↗
▶Ep 2 · 32:00
guidelineStandard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin↗
▶Ep 2 · 32:13
clinicalMetastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging↗
▶Ep 2 · 32:32
clinicalBlack, torsed ovaries should not be removed; detorsion alone is appropriate↗
▶Ep 2 · 32:44
clinicalOvarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors↗
▶Ep 2 · 32:44
quoteI think that is the sort of change over time that is something that I want to emphasize, and I think you wanted to emphasize, is that these ovaries do not need to come out unless it's a solid tumor.↗
Fred's statements about Ovarian Tumors93 statements
quoteI think ovarian is a great topic, one, it's pretty common, and I think most of us as pediatric surgeons see a lot of ovarian tumors. We see more of them than we see of like Wilms, neuroblastoma or other types of tumors↗
▶Ep 1 · 2:35
quotethere's evidence that we're doing better at that, but there's also some evidence that there are a lot of tumors that have been taken out in the last 20 years where we probably could have in retrospect, preserved some functional ovary and not done a complete oophorectomy↗
▶Ep 1 · 4:20
clinicalPredominantly cystic ovarian masses have approximately 3-4% risk of malignancy↗
▶Ep 1 · 4:20
quoteif it's predominantly cystic. Probably the chance of malignancy is probably 3 or 4%. If it's kind of a more heterogeneous, the malignancy rate might be more like 15 to 20%, and if it's solid, it's probably over 25% at least↗
▶Ep 1 · 4:35
clinicalHeterogeneous ovarian masses have approximately 15-20% malignancy risk↗
▶Ep 1 · 4:45
clinicalSolid ovarian masses have over 25% malignancy risk↗
▶Ep 1 · 4:56
epidemiologicalApproximately 10% of pediatric ovarian tumors are malignant↗
▶Ep 1 · 5:10
quoteWithin the malignant group, germ cell in children predominates, probably at least greater than 50% in some series, maybe 80%↗
▶Ep 1 · 5:10
epidemiologicalAmong malignant ovarian tumors in children, germ cell tumors comprise greater than 50% and in some series up to 80%↗
▶Ep 1 · 5:30
epidemiologicalIn benign ovarian tumors, mature teratoma represents at least half of cases↗
▶Ep 1 · 5:45
quoteIn both malignant and benign germ cell type tumors predominate↗
▶Ep 1 · 5:45
epidemiologicalImmature teratoma comprises approximately 10-15% of benign ovarian tumors↗
▶Ep 1 · 7:20
quoteI think you can still do a totally perfect oncologic operation without spilling this girl↗
▶Ep 1 · 7:50
quoteI think there are definitely some girls who present with mixed tumors where there's a solid and cystic component that turn out to be malignant. Not all the girls have elevated markers↗
▶Ep 1 · 10:20
quoteyou often can remove a liter or two of fluid. And once you get that out, you might, it might not be completely empty, but often you can deliver the tumor out of the abdominal cavity at that point↗
▶Ep 1 · 10:50
quoteWe used to recommend a contralateral biopsy. Now we only recommend a biopsy if it looks abnormal↗
▶Ep 1 · 11:10
quoteif you see a node that's enlarged to simply remove that lymph node. No rule for lymph node dissection, just a simple lymph node removal for sampling↗
▶Ep 1 · 15:50
clinicalFor large predominantly cystic ovarian masses with normal markers, the risk of malignancy is much less than 1%↗
▶Ep 1 · 15:50
quotewe did a study at our place where if they're this big and if the markers were normal and they were just predominantly cystic, the risk of malignancy was much less than 1%↗
▶Ep 1 · 16:10
quoteI don't think it makes much difference how you decompress the cyst. I think it's not wrong to put a scope in and decompress it with a trochar, aspirate it all, and then do a partial oophorectomy↗
▶Ep 1 · 16:35
quoteIt'd be almost unheard of for that to be malignant, you know, I mean, there probably at some point it'll be some child that'll have a malignancy, but then they just have to go get chemotherapy↗
▶Ep 1 · 20:00
quoteI think if possible, it would be best to take out the primary initially, you know, I say in the perfect world, go take out the primary tumor as long as you can do it with a unilateral oophorectomy↗
▶Ep 1 · 20:25
quoteif you get in there and um or if there's something on imaging that makes you think it's bilateral or if you think you can't get it out then I think neoadjuvant chemotherapy and a delayed resection is fine↗
▶Ep 1 · 21:44
quoteI think there's no reason oncologically that you have to take out the fallopian tube↗
▶Ep 1 · 21:44
clinicalThere is no oncologic requirement to remove the fallopian tube with malignant ovarian tumors if it can be preserved↗
▶Ep 1 · 22:29
clinicalCT scans are effective at detecting retroperitoneal lymph nodes and distant metastases in ovarian tumors↗
▶Ep 1 · 22:50
clinicalPeritoneal washings are the main finding that can upstage an otherwise stage 1 ovarian tumor↗
▶Ep 1 · 23:22
quotewe are primarily dealing with germ cell tumors which are very chemo responsive tumors. They're not carcinomas. I think they deal with a little bit different type of tumor for the most part. They're dealing with epithelial tumors. We're dealing with teratomas and germ cell tumors↗
▶Ep 1 · 23:22
clinicalPediatric surgeons deal primarily with germ cell tumors which are very chemo-responsive, while gynecologic surgeons deal more with epithelial tumors↗
▶Ep 1 · 23:48
quoteif the omentum is not attached to the tumor and if it on palpation is normal, we simply leave it alone. But if it would be adherent to the tumor, I would just take it with the tumor↗
▶Ep 1 · 24:17
clinicalFor ovarian germ cell tumors, chemotherapy consists of platinum-based regimen with platinum, etoposide, and bleomycin↗
▶Ep 1 · 24:17
quoteit's pretty much just chemotherapy. It's a platinum-based platinum etoposide, and bleomycin↗
▶Ep 1 · 26:10
quoteI think if you see a clear cystic component. I think it is fine to decompress it↗
▶Ep 1 · 26:35
quoteIf you think it is a tumor or a mass, let's say you don't really know if what type of it's a malignant or benign, I think it's fine to detorse it↗
▶Ep 1 · 28:37
quotequite frankly, a week is not going to make any difference to her oncologically. So if you did torse it. Give her some time to calm down, reimage it, get, get some good imaging when this is resolved, see what it looks like, check the markers, and then go back in↗
▶Ep 1 · 29:39
quotein the category of germ cell tumors, the most common one is Yolk sac tumor, but then there'll be some embryonals. There'll be some dysterminoas. There'll be a lot of mixed tumors where you might have yolk sac with mature teratoma, yolk sac with immature teratoma↗
▶Ep 1 · 30:10
quoteif you take that group of girls, those children who are stage 1, so nove is a malignancy outside the ovary, the overall survival is 96%↗
▶Ep 1 · 30:10
epidemiologicalStage 1 ovarian germ cell tumors have 96% overall survival↗
▶Ep 1 · 30:20
epidemiologicalStage 1 ovarian germ cell tumors managed without chemotherapy have approximately 50% relapse rate↗
▶Ep 1 · 30:25
quoteThere's a, there's a fairly significant relapse rate, about 50% relapse rate in the stage one treated without chemotherapy, but the salvage rate of those ones that relapse is nearly 100%↗
▶Ep 1 · 30:40
epidemiologicalThe salvage rate for relapsed stage 1 ovarian germ cell tumors is nearly 100%↗
▶Ep 1 · 30:55
quote50% received no chemotherapy at all, which is very important for things like long term. You know, avoiding the long term effects of chemotherapy↗
▶Ep 1 · 30:55
epidemiologicalApproximately 50% of stage 1 ovarian germ cell tumor patients receive no chemotherapy at all↗
▶Ep 1 · 31:30
epidemiologicalStage 2 and 3 ovarian germ cell tumors have 97% survival with chemotherapy↗
▶Ep 1 · 31:30
quoteIn stage two, the survival is actually 97%, and that's the survival for stage two and three. So that's with chemo↗
▶Ep 1 · 31:45
epidemiologicalStage 4 ovarian germ cell tumors have approximately 80% overall survival↗
▶Ep 1 · 31:45
quoteif you take stage 4, the overall survival is about 80%, but it really breaks down by your age. So if you're less than 11 years of age, it's about 92% survival, and if you're over 11, it's 60%↗
▶Ep 1 · 31:55
epidemiologicalFor stage 4 ovarian germ cell tumors, survival is approximately 92% if patient is less than 11 years of age↗
▶Ep 1 · 31:55
epidemiologicalFor stage 4 ovarian germ cell tumors, survival is approximately 60% if patient is over 11 years of age↗
▶Ep 1 · 32:32
clinicalBlack, torsed ovaries should be detorsed and preserved rather than removed↗
▶Ep 1 · 32:45
clinicalOvarian-preserving procedures should be performed for cystic or cystic with small solid component masses; only solid tumors require oophorectomy↗
▶Ep 1 · 32:45
quotethese ovaries do not need to come out unless it's a solid tumor. I think that's the critical point↗
Ovarian Tumors Video Podcast
▶Ep 2 · 2:00
quoteI think ovarian is a great topic. One, it's pretty common. And I think most of us as pediatric surgeons see a lot of ovarian tumors. We see more of them than we see of like Wilms neuroblastoma or other types of tumors, even though among the ovarian tumors, most of them are not malignant.↗
▶Ep 2 · 2:25
quoteI think it's also something where it's very important for us as pediatric surgeons to emphasize ovarian preservation. When we see things like torsion or tumors, since so many are benign, we often can preserve the ovarian.↗
▶Ep 2 · 2:45
quoteThere's evidence that we're doing better at that. But there's also some evidence that there are a lot of tumors that have been taken out in the last 20 years where we probably could have, in retrospect, preserved some functional ovary and not done a complete oophorectomy.↗
▶Ep 2 · 3:25
clinicalAlpha-fetoprotein (AFP) is the primary tumor marker for pediatric ovarian tumors; HCG is unlikely to be elevated in young children but is checked routinely↗
▶Ep 2 · 3:55
quoteI think when you look at the child, you know, one thing we're always trying to determine is, what is the risk of malignancy from the imaging?↗
▶Ep 2 · 4:03
quoteI think there's very good data that if it's predominantly cystic, probably the chance of malignancy is probably 3% or 4%. If it's kind of more heterogeneous, the malignancy rate might be more like 15% to 20%. And if it's solid, it's probably over 25% at least.↗
▶Ep 2 · 4:03
epidemiologicalPredominantly cystic ovarian masses have approximately 3-4% malignancy risk↗
▶Ep 2 · 4:25
epidemiologicalHeterogeneous ovarian masses have 15-20% malignancy rate↗
▶Ep 2 · 4:32
epidemiologicalSolid ovarian masses have over 25% malignancy risk↗
▶Ep 2 · 4:38
quoteI think it emphasized that when we do take her to the operating, we have to sort of try to preserve the principles of an oncologic operation.↗
▶Ep 2 · 5:03
epidemiologicalApproximately 10% or less of all pediatric ovarian tumors are malignant↗
▶Ep 2 · 5:18
epidemiologicalAmong malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series↗
▶Ep 2 · 5:43
epidemiologicalAmong benign pediatric ovarian tumors, mature teratoma comprises at least half of cases↗
▶Ep 2 · 5:51
epidemiologicalImmature teratoma accounts for approximately 10-15% of benign ovarian tumors↗
▶Ep 2 · 8:35
quoteI really, you know, these are pretty simple tests. They're not very hard to do. They don't hurt the child. It just takes a few extra minutes for us in there. I think it's a good principle to have kind of the standard operation in your mind all the time and for the most part to do that.↗
▶Ep 2 · 10:40
guidelineFor ovarian tumor surgery, six oncologic steps are recommended: peritoneal washings, tumor removal, contralateral ovary inspection (biopsy only if abnormal), omental assessment (remove if adherent to tumor), peritoneal cavity assessment for implants, and retroperitoneal lymph node palpation (remove only if enlarged)↗
▶Ep 2 · 10:54
guidelineContralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely↗
▶Ep 2 · 15:57
epidemiologicalFor large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1%↗
▶Ep 2 · 20:53
guidelineChest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively↗
▶Ep 2 · 21:31
clinicalFor malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present↗
▶Ep 2 · 21:42
clinicalFallopian tube preservation during oophorectomy is optional; the tube should be preserved if not encased by tumor but can be removed if adherent or difficult to separate↗
▶Ep 2 · 22:48
clinicalPeritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage↗
▶Ep 2 · 23:20
clinicalPediatric surgeons manage primarily germ cell tumors (chemo-responsive) while gynecologic oncologists manage primarily epithelial tumors, explaining differences in surgical approach including lymph node dissection↗
▶Ep 2 · 24:07
guidelineOmental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation↗
▶Ep 2 · 24:16
clinicalRadiation therapy has no role in treatment of pediatric germ cell ovarian tumors↗
▶Ep 2 · 24:32
opinionOvarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy↗
▶Ep 2 · 26:57
clinicalFor acute ovarian torsion with unclear mass characteristics, detorsion can be performed and the ovary left in place with delayed resection after obtaining markers and better imaging↗
▶Ep 2 · 28:50
clinicalA one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery↗
▶Ep 2 · 30:20
epidemiologicalStage I malignant germ cell ovarian tumors have 96% overall survival↗
▶Ep 2 · 30:33
epidemiologicalStage I germ cell tumors managed with observation alone have approximately 50% relapse rate↗
▶Ep 2 · 30:43
epidemiologicalSalvage rate for relapsed stage I germ cell tumors is nearly 100%↗
▶Ep 2 · 30:55
epidemiologicalStage II and III germ cell ovarian tumors have 97% survival with chemotherapy↗
▶Ep 2 · 31:15
epidemiologicalStage IV germ cell ovarian tumors have approximately 80% overall survival↗
▶Ep 2 · 31:23
epidemiologicalStage IV germ cell tumors in patients under 11 years have 92% survival↗
▶Ep 2 · 31:33
epidemiologicalStage IV germ cell tumors in patients over 11 years have 60% survival↗
▶Ep 2 · 31:40
quoteI think if you're over 11 and have a stage four tumor, you're high risk. If you're under 11 and you have a stage four tumor, or if you have stage two or three, you're kind of intermediate risk.↗
▶Ep 2 · 32:00
guidelineStandard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin↗
▶Ep 2 · 32:13
clinicalMetastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging↗
▶Ep 2 · 32:32
clinicalBlack, torsed ovaries should not be removed; detorsion alone is appropriate↗
▶Ep 2 · 32:44
quoteI think that is the sort of change over time that is something that I want to emphasize, and I think you wanted to emphasize, is that these ovaries do not need to come out unless it's a solid tumor.↗
▶Ep 2 · 32:44
clinicalOvarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors↗
Fred's statements about Pediatric Oncology93 statements
quoteI think ovarian is a great topic, one, it's pretty common, and I think most of us as pediatric surgeons see a lot of ovarian tumors. We see more of them than we see of like Wilms, neuroblastoma or other types of tumors↗
▶Ep 22 · 2:35
quotethere's evidence that we're doing better at that, but there's also some evidence that there are a lot of tumors that have been taken out in the last 20 years where we probably could have in retrospect, preserved some functional ovary and not done a complete oophorectomy↗
▶Ep 22 · 4:20
quoteif it's predominantly cystic. Probably the chance of malignancy is probably 3 or 4%. If it's kind of a more heterogeneous, the malignancy rate might be more like 15 to 20%, and if it's solid, it's probably over 25% at least↗
▶Ep 22 · 4:20
clinicalPredominantly cystic ovarian masses have approximately 3-4% risk of malignancy↗
▶Ep 22 · 4:35
clinicalHeterogeneous ovarian masses have approximately 15-20% malignancy risk↗
▶Ep 22 · 4:45
clinicalSolid ovarian masses have over 25% malignancy risk↗
▶Ep 22 · 4:56
epidemiologicalApproximately 10% of pediatric ovarian tumors are malignant↗
▶Ep 22 · 5:10
quoteWithin the malignant group, germ cell in children predominates, probably at least greater than 50% in some series, maybe 80%↗
▶Ep 22 · 5:10
epidemiologicalAmong malignant ovarian tumors in children, germ cell tumors comprise greater than 50% and in some series up to 80%↗
▶Ep 22 · 5:30
epidemiologicalIn benign ovarian tumors, mature teratoma represents at least half of cases↗
▶Ep 22 · 5:45
epidemiologicalImmature teratoma comprises approximately 10-15% of benign ovarian tumors↗
▶Ep 22 · 5:45
quoteIn both malignant and benign germ cell type tumors predominate↗
▶Ep 22 · 7:20
quoteI think you can still do a totally perfect oncologic operation without spilling this girl↗
▶Ep 22 · 7:50
quoteI think there are definitely some girls who present with mixed tumors where there's a solid and cystic component that turn out to be malignant. Not all the girls have elevated markers↗
▶Ep 22 · 10:20
quoteyou often can remove a liter or two of fluid. And once you get that out, you might, it might not be completely empty, but often you can deliver the tumor out of the abdominal cavity at that point↗
▶Ep 22 · 10:50
quoteWe used to recommend a contralateral biopsy. Now we only recommend a biopsy if it looks abnormal↗
▶Ep 22 · 11:10
quoteif you see a node that's enlarged to simply remove that lymph node. No rule for lymph node dissection, just a simple lymph node removal for sampling↗
▶Ep 22 · 15:50
clinicalFor large predominantly cystic ovarian masses with normal markers, the risk of malignancy is much less than 1%↗
▶Ep 22 · 15:50
quotewe did a study at our place where if they're this big and if the markers were normal and they were just predominantly cystic, the risk of malignancy was much less than 1%↗
▶Ep 22 · 16:10
quoteI don't think it makes much difference how you decompress the cyst. I think it's not wrong to put a scope in and decompress it with a trochar, aspirate it all, and then do a partial oophorectomy↗
▶Ep 22 · 16:35
quoteIt'd be almost unheard of for that to be malignant, you know, I mean, there probably at some point it'll be some child that'll have a malignancy, but then they just have to go get chemotherapy↗
▶Ep 22 · 20:00
quoteI think if possible, it would be best to take out the primary initially, you know, I say in the perfect world, go take out the primary tumor as long as you can do it with a unilateral oophorectomy↗
▶Ep 22 · 20:25
quoteif you get in there and um or if there's something on imaging that makes you think it's bilateral or if you think you can't get it out then I think neoadjuvant chemotherapy and a delayed resection is fine↗
▶Ep 22 · 21:44
clinicalThere is no oncologic requirement to remove the fallopian tube with malignant ovarian tumors if it can be preserved↗
▶Ep 22 · 21:44
quoteI think there's no reason oncologically that you have to take out the fallopian tube↗
▶Ep 22 · 22:29
clinicalCT scans are effective at detecting retroperitoneal lymph nodes and distant metastases in ovarian tumors↗
▶Ep 22 · 22:50
clinicalPeritoneal washings are the main finding that can upstage an otherwise stage 1 ovarian tumor↗
▶Ep 22 · 23:22
quotewe are primarily dealing with germ cell tumors which are very chemo responsive tumors. They're not carcinomas. I think they deal with a little bit different type of tumor for the most part. They're dealing with epithelial tumors. We're dealing with teratomas and germ cell tumors↗
▶Ep 22 · 23:22
clinicalPediatric surgeons deal primarily with germ cell tumors which are very chemo-responsive, while gynecologic surgeons deal more with epithelial tumors↗
▶Ep 22 · 23:48
quoteif the omentum is not attached to the tumor and if it on palpation is normal, we simply leave it alone. But if it would be adherent to the tumor, I would just take it with the tumor↗
▶Ep 22 · 24:17
clinicalFor ovarian germ cell tumors, chemotherapy consists of platinum-based regimen with platinum, etoposide, and bleomycin↗
▶Ep 22 · 24:17
quoteit's pretty much just chemotherapy. It's a platinum-based platinum etoposide, and bleomycin↗
▶Ep 22 · 26:10
quoteI think if you see a clear cystic component. I think it is fine to decompress it↗
▶Ep 22 · 26:35
quoteIf you think it is a tumor or a mass, let's say you don't really know if what type of it's a malignant or benign, I think it's fine to detorse it↗
▶Ep 22 · 28:37
quotequite frankly, a week is not going to make any difference to her oncologically. So if you did torse it. Give her some time to calm down, reimage it, get, get some good imaging when this is resolved, see what it looks like, check the markers, and then go back in↗
▶Ep 22 · 29:39
quotein the category of germ cell tumors, the most common one is Yolk sac tumor, but then there'll be some embryonals. There'll be some dysterminoas. There'll be a lot of mixed tumors where you might have yolk sac with mature teratoma, yolk sac with immature teratoma↗
▶Ep 22 · 30:10
epidemiologicalStage 1 ovarian germ cell tumors have 96% overall survival↗
▶Ep 22 · 30:10
quoteif you take that group of girls, those children who are stage 1, so nove is a malignancy outside the ovary, the overall survival is 96%↗
▶Ep 22 · 30:20
epidemiologicalStage 1 ovarian germ cell tumors managed without chemotherapy have approximately 50% relapse rate↗
▶Ep 22 · 30:25
quoteThere's a, there's a fairly significant relapse rate, about 50% relapse rate in the stage one treated without chemotherapy, but the salvage rate of those ones that relapse is nearly 100%↗
▶Ep 22 · 30:40
epidemiologicalThe salvage rate for relapsed stage 1 ovarian germ cell tumors is nearly 100%↗
▶Ep 22 · 30:55
quote50% received no chemotherapy at all, which is very important for things like long term. You know, avoiding the long term effects of chemotherapy↗
▶Ep 22 · 30:55
epidemiologicalApproximately 50% of stage 1 ovarian germ cell tumor patients receive no chemotherapy at all↗
▶Ep 22 · 31:30
quoteIn stage two, the survival is actually 97%, and that's the survival for stage two and three. So that's with chemo↗
▶Ep 22 · 31:30
epidemiologicalStage 2 and 3 ovarian germ cell tumors have 97% survival with chemotherapy↗
▶Ep 22 · 31:45
epidemiologicalStage 4 ovarian germ cell tumors have approximately 80% overall survival↗
▶Ep 22 · 31:45
quoteif you take stage 4, the overall survival is about 80%, but it really breaks down by your age. So if you're less than 11 years of age, it's about 92% survival, and if you're over 11, it's 60%↗
▶Ep 22 · 31:55
epidemiologicalFor stage 4 ovarian germ cell tumors, survival is approximately 60% if patient is over 11 years of age↗
▶Ep 22 · 31:55
epidemiologicalFor stage 4 ovarian germ cell tumors, survival is approximately 92% if patient is less than 11 years of age↗
▶Ep 22 · 32:32
clinicalBlack, torsed ovaries should be detorsed and preserved rather than removed↗
▶Ep 22 · 32:45
clinicalOvarian-preserving procedures should be performed for cystic or cystic with small solid component masses; only solid tumors require oophorectomy↗
▶Ep 22 · 32:45
quotethese ovaries do not need to come out unless it's a solid tumor. I think that's the critical point↗
Ovarian Tumors Video Podcast
▶Ep 253 · 2:00
quoteI think ovarian is a great topic. One, it's pretty common. And I think most of us as pediatric surgeons see a lot of ovarian tumors. We see more of them than we see of like Wilms neuroblastoma or other types of tumors, even though among the ovarian tumors, most of them are not malignant.↗
▶Ep 253 · 2:25
quoteI think it's also something where it's very important for us as pediatric surgeons to emphasize ovarian preservation. When we see things like torsion or tumors, since so many are benign, we often can preserve the ovarian.↗
▶Ep 253 · 2:45
quoteThere's evidence that we're doing better at that. But there's also some evidence that there are a lot of tumors that have been taken out in the last 20 years where we probably could have, in retrospect, preserved some functional ovary and not done a complete oophorectomy.↗
▶Ep 253 · 3:25
clinicalAlpha-fetoprotein (AFP) is the primary tumor marker for pediatric ovarian tumors; HCG is unlikely to be elevated in young children but is checked routinely↗
▶Ep 253 · 3:55
quoteI think when you look at the child, you know, one thing we're always trying to determine is, what is the risk of malignancy from the imaging?↗
▶Ep 253 · 4:03
quoteI think there's very good data that if it's predominantly cystic, probably the chance of malignancy is probably 3% or 4%. If it's kind of more heterogeneous, the malignancy rate might be more like 15% to 20%. And if it's solid, it's probably over 25% at least.↗
▶Ep 253 · 4:03
epidemiologicalPredominantly cystic ovarian masses have approximately 3-4% malignancy risk↗
▶Ep 253 · 4:25
epidemiologicalHeterogeneous ovarian masses have 15-20% malignancy rate↗
▶Ep 253 · 4:32
epidemiologicalSolid ovarian masses have over 25% malignancy risk↗
▶Ep 253 · 4:38
quoteI think it emphasized that when we do take her to the operating, we have to sort of try to preserve the principles of an oncologic operation.↗
▶Ep 253 · 5:03
epidemiologicalApproximately 10% or less of all pediatric ovarian tumors are malignant↗
▶Ep 253 · 5:18
epidemiologicalAmong malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series↗
▶Ep 253 · 5:43
epidemiologicalAmong benign pediatric ovarian tumors, mature teratoma comprises at least half of cases↗
▶Ep 253 · 5:51
epidemiologicalImmature teratoma accounts for approximately 10-15% of benign ovarian tumors↗
▶Ep 253 · 8:35
quoteI really, you know, these are pretty simple tests. They're not very hard to do. They don't hurt the child. It just takes a few extra minutes for us in there. I think it's a good principle to have kind of the standard operation in your mind all the time and for the most part to do that.↗
▶Ep 253 · 10:40
guidelineFor ovarian tumor surgery, six oncologic steps are recommended: peritoneal washings, tumor removal, contralateral ovary inspection (biopsy only if abnormal), omental assessment (remove if adherent to tumor), peritoneal cavity assessment for implants, and retroperitoneal lymph node palpation (remove only if enlarged)↗
▶Ep 253 · 10:54
guidelineContralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely↗
▶Ep 253 · 15:57
epidemiologicalFor large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1%↗
▶Ep 253 · 20:53
guidelineChest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively↗
▶Ep 253 · 21:31
clinicalFor malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present↗
▶Ep 253 · 21:42
clinicalFallopian tube preservation during oophorectomy is optional; the tube should be preserved if not encased by tumor but can be removed if adherent or difficult to separate↗
▶Ep 253 · 22:48
clinicalPeritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage↗
▶Ep 253 · 23:20
clinicalPediatric surgeons manage primarily germ cell tumors (chemo-responsive) while gynecologic oncologists manage primarily epithelial tumors, explaining differences in surgical approach including lymph node dissection↗
▶Ep 253 · 24:07
guidelineOmental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation↗
▶Ep 253 · 24:16
clinicalRadiation therapy has no role in treatment of pediatric germ cell ovarian tumors↗
▶Ep 253 · 24:32
opinionOvarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy↗
▶Ep 253 · 26:57
clinicalFor acute ovarian torsion with unclear mass characteristics, detorsion can be performed and the ovary left in place with delayed resection after obtaining markers and better imaging↗
▶Ep 253 · 28:50
clinicalA one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery↗
▶Ep 253 · 30:20
epidemiologicalStage I malignant germ cell ovarian tumors have 96% overall survival↗
▶Ep 253 · 30:33
epidemiologicalStage I germ cell tumors managed with observation alone have approximately 50% relapse rate↗
▶Ep 253 · 30:43
epidemiologicalSalvage rate for relapsed stage I germ cell tumors is nearly 100%↗
▶Ep 253 · 30:55
epidemiologicalStage II and III germ cell ovarian tumors have 97% survival with chemotherapy↗
▶Ep 253 · 31:15
epidemiologicalStage IV germ cell ovarian tumors have approximately 80% overall survival↗
▶Ep 253 · 31:23
epidemiologicalStage IV germ cell tumors in patients under 11 years have 92% survival↗
▶Ep 253 · 31:33
epidemiologicalStage IV germ cell tumors in patients over 11 years have 60% survival↗
▶Ep 253 · 31:40
quoteI think if you're over 11 and have a stage four tumor, you're high risk. If you're under 11 and you have a stage four tumor, or if you have stage two or three, you're kind of intermediate risk.↗
▶Ep 253 · 32:00
guidelineStandard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin↗
▶Ep 253 · 32:13
clinicalMetastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging↗
▶Ep 253 · 32:32
clinicalBlack, torsed ovaries should not be removed; detorsion alone is appropriate↗
▶Ep 253 · 32:44
clinicalOvarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors↗
▶Ep 253 · 32:44
quoteI think that is the sort of change over time that is something that I want to emphasize, and I think you wanted to emphasize, is that these ovaries do not need to come out unless it's a solid tumor.↗
Fred's statements about Soft Tissue Sarcoma (lymph nodes)41 statements
quoteI think ovarian is a great topic. One, it's pretty common. And I think most of us as pediatric surgeons see a lot of ovarian tumors. We see more of them than we see of like Wilms neuroblastoma or other types of tumors, even though among the ovarian tumors, most of them are not malignant.↗
▶Ep 6 · 2:25
quoteI think it's also something where it's very important for us as pediatric surgeons to emphasize ovarian preservation. When we see things like torsion or tumors, since so many are benign, we often can preserve the ovarian.↗
▶Ep 6 · 2:45
quoteThere's evidence that we're doing better at that. But there's also some evidence that there are a lot of tumors that have been taken out in the last 20 years where we probably could have, in retrospect, preserved some functional ovary and not done a complete oophorectomy.↗
▶Ep 6 · 3:25
clinicalAlpha-fetoprotein (AFP) is the primary tumor marker for pediatric ovarian tumors; HCG is unlikely to be elevated in young children but is checked routinely↗
▶Ep 6 · 3:55
quoteI think when you look at the child, you know, one thing we're always trying to determine is, what is the risk of malignancy from the imaging?↗
▶Ep 6 · 4:03
epidemiologicalPredominantly cystic ovarian masses have approximately 3-4% malignancy risk↗
▶Ep 6 · 4:03
quoteI think there's very good data that if it's predominantly cystic, probably the chance of malignancy is probably 3% or 4%. If it's kind of more heterogeneous, the malignancy rate might be more like 15% to 20%. And if it's solid, it's probably over 25% at least.↗
▶Ep 6 · 4:25
epidemiologicalHeterogeneous ovarian masses have 15-20% malignancy rate↗
▶Ep 6 · 4:32
epidemiologicalSolid ovarian masses have over 25% malignancy risk↗
▶Ep 6 · 4:38
quoteI think it emphasized that when we do take her to the operating, we have to sort of try to preserve the principles of an oncologic operation.↗
▶Ep 6 · 5:03
epidemiologicalApproximately 10% or less of all pediatric ovarian tumors are malignant↗
▶Ep 6 · 5:18
epidemiologicalAmong malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series↗
▶Ep 6 · 5:43
epidemiologicalAmong benign pediatric ovarian tumors, mature teratoma comprises at least half of cases↗
▶Ep 6 · 5:51
epidemiologicalImmature teratoma accounts for approximately 10-15% of benign ovarian tumors↗
▶Ep 6 · 8:35
quoteI really, you know, these are pretty simple tests. They're not very hard to do. They don't hurt the child. It just takes a few extra minutes for us in there. I think it's a good principle to have kind of the standard operation in your mind all the time and for the most part to do that.↗
▶Ep 6 · 10:40
guidelineFor ovarian tumor surgery, six oncologic steps are recommended: peritoneal washings, tumor removal, contralateral ovary inspection (biopsy only if abnormal), omental assessment (remove if adherent to tumor), peritoneal cavity assessment for implants, and retroperitoneal lymph node palpation (remove only if enlarged)↗
▶Ep 6 · 10:54
guidelineContralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely↗
▶Ep 6 · 15:57
epidemiologicalFor large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1%↗
▶Ep 6 · 20:53
guidelineChest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively↗
▶Ep 6 · 21:31
clinicalFor malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present↗
▶Ep 6 · 21:42
clinicalFallopian tube preservation during oophorectomy is optional; the tube should be preserved if not encased by tumor but can be removed if adherent or difficult to separate↗
▶Ep 6 · 22:48
clinicalPeritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage↗
▶Ep 6 · 23:20
clinicalPediatric surgeons manage primarily germ cell tumors (chemo-responsive) while gynecologic oncologists manage primarily epithelial tumors, explaining differences in surgical approach including lymph node dissection↗
▶Ep 6 · 24:07
guidelineOmental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation↗
▶Ep 6 · 24:16
clinicalRadiation therapy has no role in treatment of pediatric germ cell ovarian tumors↗
▶Ep 6 · 24:32
opinionOvarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy↗
▶Ep 6 · 26:57
clinicalFor acute ovarian torsion with unclear mass characteristics, detorsion can be performed and the ovary left in place with delayed resection after obtaining markers and better imaging↗
▶Ep 6 · 28:50
clinicalA one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery↗
▶Ep 6 · 30:20
epidemiologicalStage I malignant germ cell ovarian tumors have 96% overall survival↗
▶Ep 6 · 30:33
epidemiologicalStage I germ cell tumors managed with observation alone have approximately 50% relapse rate↗
▶Ep 6 · 30:43
epidemiologicalSalvage rate for relapsed stage I germ cell tumors is nearly 100%↗
▶Ep 6 · 30:55
epidemiologicalStage II and III germ cell ovarian tumors have 97% survival with chemotherapy↗
▶Ep 6 · 31:15
epidemiologicalStage IV germ cell ovarian tumors have approximately 80% overall survival↗
▶Ep 6 · 31:23
epidemiologicalStage IV germ cell tumors in patients under 11 years have 92% survival↗
▶Ep 6 · 31:33
epidemiologicalStage IV germ cell tumors in patients over 11 years have 60% survival↗
▶Ep 6 · 31:40
quoteI think if you're over 11 and have a stage four tumor, you're high risk. If you're under 11 and you have a stage four tumor, or if you have stage two or three, you're kind of intermediate risk.↗
▶Ep 6 · 32:00
guidelineStandard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin↗
▶Ep 6 · 32:13
clinicalMetastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging↗
▶Ep 6 · 32:32
clinicalBlack, torsed ovaries should not be removed; detorsion alone is appropriate↗
▶Ep 6 · 32:44
clinicalOvarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors↗
▶Ep 6 · 32:44
quoteI think that is the sort of change over time that is something that I want to emphasize, and I think you wanted to emphasize, is that these ovaries do not need to come out unless it's a solid tumor.↗
Summaries Fred gave as host
· 22 summaries
Recaps of other experts' statements, not Fred's own clinical position.
Summaries Fred gave as host · Ovarian Tumors9 summaries
host summaryFred Rescorla summarizing a resource: I saw a few years ago in one of Dr. Deborah Belmeyer's papers was a group of stage 3 ovarian tumors, I think there were 20 of them, 5 of them were stage 3 only because their peritoneal fluid was positive for malignant cells↗
▶Ep 1 · 8:10
host summaryFred Rescorla summarizing a resource: In a study of stage 3 ovarian tumors with 20 patients, 5 were stage 3 only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage 1 with likely higher recurrence↗
▶Ep 1 · 26:50
host summaryFred Rescorla summarizing a resource: A recent study in Fertility and Sterility Journal demonstrated that premenarchal girls have higher risk of ovarian torsion↗
▶Ep 1 · 26:50
host summaryFred Rescorla summarizing a resource: There's a recent study out of the Fertility and Sterility Journal demonstrating that pre-medical girls have a higher risk of torsion. And their recommendation was that if it's a premal girl or if somebody's had a torsion of that same ovary before to go ahead and do an oophoropexy at that time↗
▶Ep 1 · 27:10
host summaryFred Rescorla summarizing a resource: The recommendation from the Fertility and Sterility study is to perform oophoropexy in premenarchal girls or if the same ovary has torsed before↗
Ovarian Tumors Video Podcast
▶Ep 2 · 8:10
host summaryFred Rescorla summarizing a resource: I think one interesting thing I saw a few years ago in one of Dr. Deborah Billmar's papers was a group of stage 3 ovarian tumors. I think there were 20 of them. Five of them were stage 3 only because their peritoneal fluid was positive for malignant cells.↗
▶Ep 2 · 8:10
host summaryFred Rescorla summarizing a resource: In a study of 20 stage III ovarian tumors, 5 were stage III only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage I with likely higher recurrence↗
▶Ep 2 · 26:57
host summaryFred Rescorla summarizing a resource: Pre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents↗
▶Ep 2 · 27:12
host summaryFred Rescorla summarizing a resource: Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary↗
Summaries Fred gave as host · Pediatric Oncology9 summaries
host summaryFred Rescorla summarizing a resource: I saw a few years ago in one of Dr. Deborah Belmeyer's papers was a group of stage 3 ovarian tumors, I think there were 20 of them, 5 of them were stage 3 only because their peritoneal fluid was positive for malignant cells↗
▶Ep 22 · 8:10
host summaryFred Rescorla summarizing a resource: In a study of stage 3 ovarian tumors with 20 patients, 5 were stage 3 only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage 1 with likely higher recurrence↗
▶Ep 22 · 26:50
host summaryFred Rescorla summarizing a resource: A recent study in Fertility and Sterility Journal demonstrated that premenarchal girls have higher risk of ovarian torsion↗
▶Ep 22 · 26:50
host summaryFred Rescorla summarizing a resource: There's a recent study out of the Fertility and Sterility Journal demonstrating that pre-medical girls have a higher risk of torsion. And their recommendation was that if it's a premal girl or if somebody's had a torsion of that same ovary before to go ahead and do an oophoropexy at that time↗
▶Ep 22 · 27:10
host summaryFred Rescorla summarizing a resource: The recommendation from the Fertility and Sterility study is to perform oophoropexy in premenarchal girls or if the same ovary has torsed before↗
Ovarian Tumors Video Podcast
▶Ep 253 · 8:10
host summaryFred Rescorla summarizing a resource: I think one interesting thing I saw a few years ago in one of Dr. Deborah Billmar's papers was a group of stage 3 ovarian tumors. I think there were 20 of them. Five of them were stage 3 only because their peritoneal fluid was positive for malignant cells.↗
▶Ep 253 · 8:10
host summaryFred Rescorla summarizing a resource: In a study of 20 stage III ovarian tumors, 5 were stage III only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage I with likely higher recurrence↗
▶Ep 253 · 26:57
host summaryFred Rescorla summarizing a resource: Pre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents↗
▶Ep 253 · 27:12
host summaryFred Rescorla summarizing a resource: Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary↗
Summaries Fred gave as host · Soft Tissue Sarcoma (lymph nodes)4 summaries
host summaryFred Rescorla summarizing a resource: In a study of 20 stage III ovarian tumors, 5 were stage III only because peritoneal fluid was positive for malignant cells; without checking washings they would have been considered stage I with likely higher recurrence↗
▶Ep 6 · 8:10
host summaryFred Rescorla summarizing a resource: I think one interesting thing I saw a few years ago in one of Dr. Deborah Billmar's papers was a group of stage 3 ovarian tumors. I think there were 20 of them. Five of them were stage 3 only because their peritoneal fluid was positive for malignant cells.↗
▶Ep 6 · 26:57
host summaryFred Rescorla summarizing a resource: Pre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents↗
▶Ep 6 · 27:12
host summaryFred Rescorla summarizing a resource: Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary↗
