Ovarian Tumors Video Podcast

Alpha-fetoprotein (AFP) is the primary tumor marker for pediatric ovarian tumors; HCG is unlikely to be elevated in young children but is checked routinely

Predominantly cystic ovarian masses have approximately 3-4% malignancy risk

Heterogeneous ovarian masses have 15-20% malignancy rate

Solid ovarian masses have over 25% malignancy risk

Approximately 10% or less of all pediatric ovarian tumors are malignant

Among malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series

Among benign pediatric ovarian tumors, mature teratoma comprises at least half of cases

Immature teratoma accounts for approximately 10-15% of benign ovarian tumors

For 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)

Contralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely

For large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1%

Chest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively

For malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present

Fallopian 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

Peritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage

Pediatric surgeons manage primarily germ cell tumors (chemo-responsive) while gynecologic oncologists manage primarily epithelial tumors, explaining differences in surgical approach including lymph node dissection

Omental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation

Radiation therapy has no role in treatment of pediatric germ cell ovarian tumors

Ovarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy

For 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

A one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery

Stage I malignant germ cell ovarian tumors have 96% overall survival

Stage I germ cell tumors managed with observation alone have approximately 50% relapse rate

Salvage rate for relapsed stage I germ cell tumors is nearly 100%

Stage II and III germ cell ovarian tumors have 97% survival with chemotherapy

Stage IV germ cell ovarian tumors have approximately 80% overall survival

Stage IV germ cell tumors in patients under 11 years have 92% survival

Stage IV germ cell tumors in patients over 11 years have 60% survival

Standard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin

Metastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging

Black, torsed ovaries should not be removed; detorsion alone is appropriate

Ovarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors