# Ovarian & Gynecologic Tumors — GCMD Library living collection

Updated: n/a · 6 episodes · 52 cited statements

## Episodes
### Benign Ovarian Lesions
- [Ovarian Cysts with Dr. Roshni Dasgupta](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665) — video · [machine version](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665.md)

### Ovarian Neoplasms
- [Ovarian Tumors with Dr. Roshni Dasgupta](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829) — video · [machine version](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829.md)
- [Ovarian neoplasms — the role of minimally invasive surgery](https://library.globalcastmd.com/watch/ovarian-neoplasms-the-role-of-minimally-invasive-surgery-16296) — article · [machine version](https://library.globalcastmd.com/watch/ovarian-neoplasms-the-role-of-minimally-invasive-surgery-16296.md)

### Immature Teratoma
- [Immature teratoma of the ovary with microscopic yolk sac tumor in children and adolescents: A multi-institutional study](https://library.globalcastmd.com/watch/immature-teratoma-of-the-ovary-with-microscopic-yolk-sac-tumor-in-children-and-a-16286) — article · [machine version](https://library.globalcastmd.com/watch/immature-teratoma-of-the-ovary-with-microscopic-yolk-sac-tumor-in-children-and-a-16286.md)
- [Immature teratoma of the ovary in children and adolescents: A multi-institutional study of characteristics and management](https://library.globalcastmd.com/watch/immature-teratoma-of-the-ovary-in-children-and-adolescents-a-multi-institutional-16287) — article · [machine version](https://library.globalcastmd.com/watch/immature-teratoma-of-the-ovary-in-children-and-adolescents-a-multi-institutional-16287.md)

### Fertility Preservation
- [Surgeon perceptions on fertility counseling and preservation in children with cancer: A multicenter survey of North American Hospitals](https://library.globalcastmd.com/watch/surgeon-perceptions-on-fertility-counseling-and-preservation-in-children-with-ca-16264) — article · [machine version](https://library.globalcastmd.com/watch/surgeon-perceptions-on-fertility-counseling-and-preservation-in-children-with-ca-16264.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=0) Neonatal ovarian cysts: prenatal diagnosis and initial management (Ep 1)
- [2:06](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=126) Surgical indications and management of persistent or complex cysts (Ep 1)
- [4:10](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=250) Closing remarks (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=0) Introduction to ovarian pathology in pediatric surgery (Ep 2)
- [0:55](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=55) Classification of neoplastic ovarian masses and genetic syndromes (Ep 2)
- [2:36](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=156) Workup of an 8-year-old with palpable mass and precocious puberty (Ep 2)
- [7:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=420) Germ cell tumor embryology and classification (Ep 2)
- [10:44](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=644) Surgical staging and treatment of germ cell tumors (Ep 2)
- [13:31](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=811) Chemotherapy for germ cell tumors and management of teratomas (Ep 2)
- [17:23](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1043) Epithelial ovarian tumors: staging and fertility-sparing approaches (Ep 2)
- [20:26](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1226) Summary of tumor markers and closing remarks (Ep 2)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Neoplastic ovarian masses are classified into three types based on tissue of origin: epithelial ovarian tumors, stromal/sex cord tumors, and germ cell tumors (from the yolk sac). — Roshni Dasgupta (clinical) [Ep 2 · 0:55](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=55)
- Malignancy from neoplastic ovarian processes is rare, making up only 2% of cancers in children overall. — Roshni Dasgupta (epidemiological) [Ep 2 · 1:35](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=95)
- Ovarian malignancy is more common in the 10-19 year age group and any malignant lesion under age 5 is reportable. — Roshni Dasgupta (clinical) [Ep 2 · 1:45](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=105)
- Peutz-Jeghers syndrome is associated primarily with granulosa cell tumors and sex cord tumors. — Roshni Dasgupta (clinical) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=120)
- Ollier and Maffucci syndromes are associated with ovarian tumors. — Roshni Dasgupta (clinical) [Ep 2 · 2:10](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=130)
- Chediak-Higashi and McCune-Albright syndromes are also associated with ovarian tumors. — Roshni Dasgupta (clinical) [Ep 2 · 2:18](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=138)
- Workup for suspected ovarian tumor with precocious puberty includes renal panel, CBC, estradiol, progesterone, tumor markers, and ultrasound. — Roshni Dasgupta (clinical) [Ep 2 · 3:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=180)
- CT scan advantages for ovarian mass evaluation include better determination of tumor location and extent, and superior detection of calcifications compared to MRI. — Roshni Dasgupta (clinical) [Ep 2 · 3:50](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=230)
- CT scan disadvantage is radiation exposure to the child. — Roshni Dasgupta (clinical) [Ep 2 · 4:10](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=250)
- MRI provides better tissue detail, can help distinguish ovarian from parovarian masses, and is excellent at detecting lymph nodes. — Roshni Dasgupta (clinical) [Ep 2 · 4:18](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=258)
- Tumor markers commonly associated with ovarian tumors include AFP, beta-hCG, CA-125 (for epithelial tumors), inhibin A and B, hormones (estradiol, progesterone), LDH, CBC, and renal function tests. — Roshni Dasgupta (clinical) [Ep 2 · 5:01](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=301)
- Elevated inhibin B is associated with granulosa cell tumor, a sex cord tumor that causes virilizing effects. — Roshni Dasgupta (clinical) [Ep 2 · 5:40](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=340)
- CA-125 can be elevated in benign conditions such as endometriosis and other inflammatory conditions, sometimes to levels that overlap with malignancy. — Roshni Dasgupta (clinical) [Ep 2 · 6:34](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=394)
- Primordial germ cells form in the first week of gestation, and by week three they form the wall of the yolk sac and migrate along the mesentery of the hindgut. — Roshni Dasgupta (clinical) [Ep 2 · 7:15](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=435)
- Germ cell tumors can be gonadal (when germ cells migrate to the gonads) or extragonadal (sacrococcygeal teratomas, mediastinal lesions). — Roshni Dasgupta (clinical) [Ep 2 · 7:45](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=465)
- Within gonadal germ cell tumors, if cells differentiate properly, extraembryonic differentiation produces choriocarcinomas and yolk sac tumors, while embryonic differentiation produces teratomas and mixed germ cell tumors. — Roshni Dasgupta (clinical) [Ep 2 · 8:10](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=490)
- If germ cells do not differentiate properly, they are classified as seminomas in boys and dysgerminomas in girls. — Roshni Dasgupta (clinical) [Ep 2 · 8:50](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=530)
- About 20% of germ cell tumors are malignant. — Roshni Dasgupta (epidemiological) [Ep 2 · 9:20](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=560)
- Dysgerminomas are the most common malignant histology, comprising 30% of germ cell tumors, and can be bilateral. — Roshni Dasgupta (epidemiological) [Ep 2 · 9:35](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=575)
- Dysgerminomas have a unique laboratory pattern: elevated LDH, but in a pure dysgerminoma AFP and beta-hCG can be normal; hypercalcemia may also be present. — Roshni Dasgupta (clinical) [Ep 2 · 9:48](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=588)
- Germ cell tumor staging requires peritoneal washings, examination of the entire peritoneal cavity, omental resection only if suspicious nodules are present, and unilateral salpingo-oophorectomy (salpingectomy only if fallopian tube is involved). — Roshni Dasgupta (clinical) [Ep 2 · 11:12](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=672)
- For germ cell tumors, lymph nodes should be examined intraoperatively but only removed if enlarged or suspicious; standard lymph node dissection is not required. — Roshni Dasgupta (clinical) [Ep 2 · 11:12](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=672)
- Any portion of the ovary that can be preserved should be considered during germ cell tumor resection. — Roshni Dasgupta (clinical) [Ep 2 · 11:50](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=710)
- COG staging for germ cell tumors: stage I is limited to the ovary with negative washings; stage II includes capsular rupture with negative washings; stage III is lymph node involvement; stage IV is distant metastasis. — Roshni Dasgupta (guideline) [Ep 2 · 12:42](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=762)
- Stage I germ cell tumors can be managed with surgery alone and observation if the tumor is not ruptured. — Roshni Dasgupta (clinical) [Ep 2 · 13:31](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=811)
- If a germ cell tumor is ruptured during laparoscopic resection and tumor is spilled, the patient is required to receive chemotherapy. — Roshni Dasgupta (clinical) [Ep 2 · 14:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=840)
- For mature teratomas with a cystic component, it is safe to decompress the cyst first to improve access and increase chances of ovarian preservation. — Roshni Dasgupta (clinical) [Ep 2 · 16:30](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=990)
- The ovarian capsule does not need to be closed after shelling out a teratoma; there is no data showing closure is necessary and it will form by itself. — Roshni Dasgupta (clinical) [Ep 2 · 16:55](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1015)
- A plastic bowel bag can be glued to the ovarian mass and a needle inserted through it to avoid spillage during teratoma resection. — Roshni Dasgupta (clinical) [Ep 2 · 17:10](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1030)
- Spillage of teratoma contents can cause growing teratoma syndrome, where teratoma grows throughout the abdomen and is not responsive to chemotherapy. — Roshni Dasgupta (clinical) [Ep 2 · 17:23](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1043)
- Staging for epithelial ovarian tumors requires pelvic washings, abdominal examination, omentectomy, primary tumor removal, and lymph node dissection. — Roshni Dasgupta (clinical) [Ep 2 · 18:31](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1111)
- For epithelial tumors, lymph node dissection boundaries are the pelvic iliacs to the renal artery (para-aortic nodes below the renals). — Roshni Dasgupta (clinical) [Ep 2 · 18:55](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1135)
- About 30% of normal-appearing lymph nodes in epithelial ovarian cancer are positive on pathology, which will upstage the patient. — Roshni Dasgupta (epidemiological) [Ep 2 · 19:23](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1163)
- Borderline epithelial tumors can recur, so patients require close serial follow-up over many years. — Roshni Dasgupta (clinical) [Ep 2 · 20:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1200)
- For borderline epithelial tumors, ovarian-sparing surgery can be performed initially, and if pathology confirms borderline tumor, the ovary can either be removed in a second operation or the patient can be watched with close surveillance. — Roshni Dasgupta (clinical) [Ep 2 · 20:26](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1226)
- There is no perfect tumor marker for ovarian masses; studies from the Midwest Pediatric Surgery Consortium show that a panel of tumor markers is helpful, but no single marker perfectly predicts malignancy. — Roshni Dasgupta (clinical) [Ep 2 · 21:00](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1260)
- Cysts diagnosed prenatally have a differential including ovarian cyst, mesenteric cyst, duplication cyst, complex meconium cyst, or renal cyst. — Roshni Dasgupta (clinical) [Ep 1 · 0:25](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=25)
- There is not much to do in utero for prenatally diagnosed pelvic cysts. — Roshni Dasgupta (clinical) [Ep 1 · 1:00](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=60)
- For a thriving neonate with a truly cystic mass, serial imaging at about 12 weeks is appropriate if it is a simple cyst, which should get smaller in that timeframe. — Roshni Dasgupta (clinical) [Ep 1 · 1:10](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=70)
- If abnormal ovaries or no ovaries are seen on imaging, intrauterine torsion may have occurred, leaving a free floating cyst. — Roshni Dasgupta (clinical) [Ep 1 · 1:35](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=95)
- Prenatal ovarian cysts are really common and usually diagnosed around 28 weeks gestation. (epidemiological) [Ep 1 · 2:06](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=126)
- Prenatal ovarian cysts are rarely associated with malignancy and most go away by themselves. (clinical) [Ep 1 · 2:25](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=145)
- Indications for surgery include development of symptoms, cysts over 5 centimeters (increased risk of torsion), or persistence for greater than 6 months with no decrease in size. (clinical) [Ep 1 · 2:35](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=155)
- If a cyst persists for greater than 6 months with no decrease in size, it may not be part of the ovary and could be a mesenteric cyst or something else requiring further investigation. (clinical) [Ep 1 · 3:05](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=185)
- In adolescence, the same rules apply for ovarian cysts, with main concern being size due to increased risk of torsion, and serial imaging can be used. (clinical) [Ep 1 · 3:20](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=200)
- Other kinds of ovarian cysts found in adolescence can be pretty large, composed of granulosa and thecal cells, and can cause torsion. (clinical) [Ep 1 · 3:35](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=215)
- When ovarian cysts are seen incidentally during appendicitis workup, they should be left alone and followed with ultrasound in about 6 weeks. (clinical) [Ep 1 · 3:50](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=230)
- Paraovarian cysts are hard to differentiate from follicular cysts on imaging. — Roshni Dasgupta (clinical) [Ep 1 · 4:02](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=242)
- The big concern with paraovarian cysts is torsion of the fallopian tube itself, not just the ovary. — Roshni Dasgupta (clinical) [Ep 1 · 4:10](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=250)
- Paraovarian cysts are usually in the mesosalpinx. — Roshni Dasgupta (clinical) [Ep 1 · 4:20](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=260)
- If paraovarian cysts are greater than 3 centimeters, enucleation is recommended to prevent torsion of the tube. — Roshni Dasgupta (clinical) [Ep 1 · 4:25](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=265)
- If paraovarian cysts are smaller than 3 centimeters, most people do not intervene, but they can be opened and drained if desired. — Roshni Dasgupta (opinion) [Ep 1 · 4:35](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=275)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- MRI disadvantages include longer acquisition time (sometimes requiring anesthesia), reduced availability, and higher cost. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 4:34](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=274)
- AFP is the primary tumor marker for germ cell disease. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 9:28](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=568)
- PEB chemotherapy (platinum, etoposide, bleomycin) is the standard approach for germ cell tumors requiring adjuvant treatment and is very effective. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 14:42](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=882)
- Six-year overall survival with PEB chemotherapy is excellent even in stage IV germ cell tumor patients. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 15:05](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=905)
- Teratomas consist of all three primordial tissue types (ectoderm, mesoderm, endoderm) and can contain brain, bone, and teeth. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 15:20](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=920)
- Cystic teratomas are the most common type and can be bilateral in about 10% of patients. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 15:40](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=940)
- Calcifications are often visible in teratomas, making CT scan useful for detection. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 15:50](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=950)
- Immature teratomas have neuroepithelial components graded 0-3; higher grades are more likely to have yolk sac foci and malignant behavior. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 15:58](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=958)
- Most immature teratomas do not need chemotherapy after resection. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 16:20](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=980)
- Epithelial ovarian tumors account for about 20% of pediatric ovarian tumors, which is relatively rare compared to adults. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 18:06](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1086)
- Epithelial tumors are mucinous and serous; serous lesions are more commonly bilateral than mucinous. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 18:20](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1100)
- Borderline epithelial tumors are more common in children and have a better prognosis than invasive ovarian cancer. — Em Gootee or Todd Ponsky summarizes what Dr. Roshni Dasgupta said [Ep 2 · 19:40](https://library.globalcastmd.com/watch/ovarian-tumors-with-dr-roshni-dasgupta-5829?t=1180)
- Ovarian pathology can affect children at all stages of life, with differential and workup differing based on age of presentation and size of mass. — The host summarizes what Dr. Roshni Dasgupta said [Ep 1 · 0:00](https://library.globalcastmd.com/watch/ovarian-cysts-with-dr-roshni-dasgupta-5665?t=0)

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