Compiled Hayes Jordan Rapid Fire Sessions: Update Course 2015
With Dr. Andrea Hayes-Jordan · hosted by Dr. Todd Ponsky · StayCurrentMD
Part of
Sarcoma (Ewing/Rhabdo) 36 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
80% of ovarian masses in children are teratomas
By the year 2000, girls with ovarian germ cell tumors have almost 100% survival
Stage 1 ovarian germ cell tumors (limited to ovary) now receive only oophorectomy without chemotherapy
Peritoneal cytology/washings will miss approximately 25% of girls with disease if not performed
If staging procedures are omitted from the operative report, oncologists will treat the patient as stage 2
Gliomatosis peritonei is a benign disease with 100% survival, typically associated with ovarian teratomas
For bilateral ovarian disease, tumors larger than 10 centimeters should be biopsied, with lower threshold for bilateral oophorectomy on first operation
If a presumed teratoma is ruptured during laparoscopic removal, the patient is committed to chemotherapy including platinum
15% of ovarian tumors in the teenage age range are actually epithelial tumors with different staging criteria than germ cell tumors
If preoperative AFP and beta-HCG levels are normal, there is increased comfort (though not 100%) about draining a cystic ovarian mass
The salvage rate for patients with recurrent ovarian germ cell tumors is almost 100% because chemotherapy is very effective
Ovarian torsion should be considered an urgent rather than emergent situation if the goal is ovarian preservation
Many black-colored ovaries from torsion actually contain viable follicles and ovarian preservation should be the goal
76% of ovaries removed for torsion (that surgeons judged to be dead) contained normal ovarian tissue on pathology; only 11% were completely necrotic
The ability to preserve ovarian function after torsion is related to patient age, with pediatric patients having more active follicles than older adults
The current recommendation is detorsion without complete oophorectomy for ovarian torsion
Ultrasound Doppler has only 50-60% sensitivity and specificity for diagnosing ovarian torsion
Half of soft tissue sarcomas are rhabdomyosarcomas and half are non-rhabdomyosarcomas
In rhabdomyosarcoma, prognosis varies by site, with abdominal/pelvic/retroperitoneal tumors having the worst survival and orbital tumors having the best
The surgeon determines the clinical group in rhabdomyosarcoma based on surgical extent: group 1 is complete resection, group 2 is microscopic residual, group 3 is biopsy only
Group 1 and 2 rhabdomyosarcoma patients have excellent prognosis; group 3 patients do more poorly
Attempting to resect a large unresectable rhabdomyosarcoma with high morbidity will not improve the patient's outcome; this is a biologic determination, not a reflection of surgical skill
A 4-centimeter mass in the forearm of a 5-year-old is relatively huge and should probably be biopsied rather than resected initially
Sentinel lymph node biopsy is now required for all trunk and extremity rhabdomyosarcomas
For rhabdomyosarcoma, completion lymph node dissection is not performed for positive sentinel nodes; patients receive radiation therapy instead
40-50% of biopsied lymph nodes are positive in rhabdomyosarcoma, and clinically negative nodes may also be positive
For non-rhabdomyosarcoma soft tissue sarcomas, histologic grade is now critical and determines treatment
Low-grade soft tissue sarcomas require only resection and observation; no chemotherapy or radiation unless margins are positive
For unresectable soft tissue sarcomas, preoperative radiation therapy and chemotherapy are now recommended (previously only chemotherapy)
Chemosensitive soft tissue sarcomas include synovial sarcoma and undifferentiated sarcoma
Chemoinsensitive soft tissue sarcomas include alveolar soft part sarcoma, malignant epithelioid, and clear cell sarcoma; surgery and radiation are the primary treatments
A 5-centimeter tumor in a child less than 3 years old is equivalent to a 3-centimeter tumor in a larger patient, so 3 centimeters should be the cutoff for excision in toddlers
Low-grade non-rhabdomyosarcoma soft tissue sarcomas with negative margins can be cured with surgery alone and do not need chemotherapy
Core biopsies are acceptable for soft tissue sarcomas if 3-4 good non-necrotic cores are obtained, confirmed by pathologist during the procedure
Good blood flow on ultrasound does not rule out torsion because the ovary may be intermittently twisted