Fred Rescorla

131 statements · 2 topics · summaries given as host listed separately

Abdominal Wall Defects · guest expert Etiologies (Gastroschisis/NEC/Atresia/Volvulus) · guest expert Intestinal Rehab · guest expert

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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.
quote · Ovarian Torsion
I 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.
quote · Ovarian Torsion
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)
guideline · Soft Tissue Sarcoma (lymph nodes)
Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary
guideline · Soft Tissue Sarcoma (lymph nodes)

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Fred's statements about Ovarian Torsion 45 statements

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Ovarian Tumors Video Podcast

Quotation I 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. Open
Quotation 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. Open
Quotation There'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. Open
Statement 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 Open
Quotation I 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? Open
Statement Predominantly cystic ovarian masses have approximately 3-4% malignancy risk Open
Quotation 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. Open
Statement Heterogeneous ovarian masses have 15-20% malignancy rate Open
Statement Solid ovarian masses have over 25% malignancy risk Open
Quotation I 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. Open
Statement Approximately 10% or less of all pediatric ovarian tumors are malignant Open
Statement Among malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series Open
Statement Among benign pediatric ovarian tumors, mature teratoma comprises at least half of cases Open
Statement Immature teratoma accounts for approximately 10-15% of benign ovarian tumors Open
Quotation 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. Open
Statement 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 Open
Quotation I 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. Open
Statement 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) Open
Statement Contralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely Open
Statement For large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1% Open
Statement Chest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively Open
Statement For malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present Open
Statement 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 Open
Statement Peritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage Open
Statement 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 Open
Statement Omental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation Open
Statement Radiation therapy has no role in treatment of pediatric germ cell ovarian tumors Open
Statement Ovarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy Open
Statement 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 Open
Statement Pre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents Open
Statement Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary Open
Statement A one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery Open
Statement Stage I malignant germ cell ovarian tumors have 96% overall survival Open
Statement Stage I germ cell tumors managed with observation alone have approximately 50% relapse rate Open
Statement Salvage rate for relapsed stage I germ cell tumors is nearly 100% Open
Statement Stage II and III germ cell ovarian tumors have 97% survival with chemotherapy Open
Statement Stage IV germ cell ovarian tumors have approximately 80% overall survival Open
Statement Stage IV germ cell tumors in patients under 11 years have 92% survival Open
Statement Stage IV germ cell tumors in patients over 11 years have 60% survival Open
Quotation I 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. Open
Statement Standard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin Open
Statement Metastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging Open
Statement Black, torsed ovaries should not be removed; detorsion alone is appropriate Open
Quotation I 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. Open
Statement Ovarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors Open
Fred's statements about Soft Tissue Sarcoma (lymph nodes) 86 statements

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Ovarian Tumors Video Podcast

Quotation I 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. Open
Quotation I 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. Open
Quotation 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. Open
Quotation 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. Open
Quotation There'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. Open
Quotation There'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. Open
Statement 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 Open
Statement 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 Open
Quotation I 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? Open
Quotation I 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? Open
Statement Predominantly cystic ovarian masses have approximately 3-4% malignancy risk Open
Statement Predominantly cystic ovarian masses have approximately 3-4% malignancy risk Open
Quotation 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. Open
Quotation 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. Open
Statement Heterogeneous ovarian masses have 15-20% malignancy rate Open
Statement Heterogeneous ovarian masses have 15-20% malignancy rate Open
Statement Solid ovarian masses have over 25% malignancy risk Open
Statement Solid ovarian masses have over 25% malignancy risk Open
Quotation I 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. Open
Quotation I 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. Open
Statement Approximately 10% or less of all pediatric ovarian tumors are malignant Open
Statement Approximately 10% or less of all pediatric ovarian tumors are malignant Open
Statement Among malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series Open
Statement Among malignant pediatric ovarian tumors, germ cell tumors predominate at greater than 50%, possibly up to 80% in some series Open
Statement Among benign pediatric ovarian tumors, mature teratoma comprises at least half of cases Open
Statement Among benign pediatric ovarian tumors, mature teratoma comprises at least half of cases Open
Statement Immature teratoma accounts for approximately 10-15% of benign ovarian tumors Open
Statement Immature teratoma accounts for approximately 10-15% of benign ovarian tumors Open
Statement 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 Open
Quotation 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. Open
Quotation I 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. Open
Quotation I 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. Open
Statement 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) Open
Statement 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) Open
Statement Contralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely Open
Statement Contralateral ovarian biopsy is now recommended only if the ovary appears abnormal, not routinely Open
Statement For large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1% Open
Statement For large predominantly cystic ovarian masses with normal markers, the malignancy risk is much less than 1% Open
Statement Chest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively Open
Statement Chest CT is required for staging of malignant ovarian tumors and should be obtained preoperatively Open
Statement For malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present Open
Statement For malignant ovarian tumors amenable to resection, primary surgical resection is preferred even if metastases are present Open
Statement 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 Open
Statement 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 Open
Statement Peritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage Open
Statement Peritoneal washings are the main factor that can upstage an otherwise apparent stage I tumor to a higher stage Open
Statement 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 Open
Statement 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 Open
Statement Omental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation Open
Statement Omental biopsy is not routine; omentum should be removed only if adherent to tumor or if abnormal on palpation Open
Statement Radiation therapy has no role in treatment of pediatric germ cell ovarian tumors Open
Statement Radiation therapy has no role in treatment of pediatric germ cell ovarian tumors Open
Statement Ovarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy Open
Statement Ovarian cryopreservation is not currently standard practice but may be considered in the future for patients receiving chemotherapy Open
Statement 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 Open
Statement Pre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents Open
Statement 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 Open
Statement Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary Open
Statement A one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery Open
Statement A one-week delay for re-operation after detorsion makes no oncologic difference and allows for proper workup and ovarian-preserving surgery Open
Statement Stage I malignant germ cell ovarian tumors have 96% overall survival Open
Statement Stage I malignant germ cell ovarian tumors have 96% overall survival Open
Statement Stage I germ cell tumors managed with observation alone have approximately 50% relapse rate Open
Statement Stage I germ cell tumors managed with observation alone have approximately 50% relapse rate Open
Statement Salvage rate for relapsed stage I germ cell tumors is nearly 100% Open
Statement Salvage rate for relapsed stage I germ cell tumors is nearly 100% Open
Statement Stage II and III germ cell ovarian tumors have 97% survival with chemotherapy Open
Statement Stage II and III germ cell ovarian tumors have 97% survival with chemotherapy Open
Statement Stage IV germ cell ovarian tumors have approximately 80% overall survival Open
Statement Stage IV germ cell ovarian tumors have approximately 80% overall survival Open
Statement Stage IV germ cell tumors in patients under 11 years have 92% survival Open
Statement Stage IV germ cell tumors in patients under 11 years have 92% survival Open
Statement Stage IV germ cell tumors in patients over 11 years have 60% survival Open
Statement Stage IV germ cell tumors in patients over 11 years have 60% survival Open
Quotation I 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. Open
Quotation I 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. Open
Statement Standard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin Open
Statement Standard chemotherapy for intermediate-risk germ cell tumors is platinum, etoposide, and bleomycin Open
Statement Metastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging Open
Statement Metastatic sites in stage IV germ cell tumors do not require biopsy if clearly metastatic on imaging; they are followed with imaging Open
Statement Black, torsed ovaries should not be removed; detorsion alone is appropriate Open
Statement Black, torsed ovaries should not be removed; detorsion alone is appropriate Open
Statement Ovarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors Open
Statement Ovarian-preserving procedures (partial oophorectomy) are appropriate for cystic or mixed cystic-solid masses; oophorectomy is reserved for solid tumors Open
Quotation I 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. Open
Quotation I 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. Open

Summaries Fred gave as host · 4 summaries

Recaps of other experts' statements, not Fred's own clinical position.

Summaries Fred gave as host · Soft Tissue Sarcoma (lymph nodes) 4 summaries

Open the Soft Tissue Sarcoma (lymph nodes) collection →

Ovarian Tumors Video Podcast

Host summary Fred 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. Open
Host summary Fred 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 Open
Host summary Fred Rescorla summarizing a resource: Pre-menarchal girls have a higher risk of ovarian torsion compared to post-menarchal adolescents Open
Host summary Fred Rescorla summarizing a resource: Oophoropexy is recommended for pre-menarchal girls with ovarian torsion or for patients with recurrent torsion of the same ovary Open