Care pathway · Surgical approach decision / Gynecology / Gynecologic oncology · for licensed clinicians

Ovarian Sex Cord-Stromal Tumor · Surgery

Granulosa cell tumor etc. early young fertility-sparing (ipsilateral adnexa + staging); completed childbearing TAH-BSO + staging; estrogenic type needs endometrial assessment.

Based on: NCCN/ESGO · nodes are our own synthesis of the guideline's decision logic, not the guideline verbatim
Clinical takeaway

Early young → fertility-sparing surgery: Granulosa cell/Sertoli-Leydig cell tumor etc., early and young → fertility-sparing surgery (ipsilateral adnexa + staging); adult granulosa …

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

Step 1 · Type + fertility + endocrine
Type? Fertility-sparing? Endocrine symptoms?

Full pathway

  1. [Decision] Type + fertility + endocrine
    Type? Fertility-sparing? Endocrine symptoms?
    • Granulosa cell tumor etc., early, young, wants fertility preservation → Early young → fertility-sparing surgery
    • Completed childbearing/advanced → Completed childbearing/advanced → staging/debulking
    • Endocrine symptoms (estrogen/androgen) needing assessment → Endocrine type → assess the endometrium
  2. [End] Early young → fertility-sparing surgery
    Granulosa cell/Sertoli-Leydig cell tumor etc., early and young → fertility-sparing surgery (ipsilateral adnexa + staging); adult granulosa cell tumors can recur late, long-term follow-up (inhibin B/AMH).
  3. [End] Completed childbearing/advanced → staging/debulking
    Completed childbearing/advanced → total hysterectomy + bilateral salpingo-oophorectomy + staging/debulking; chemotherapy for advanced/recurrent disease.
  4. [End] Endocrine type → assess the endometrium
    Estrogenic presentation (granulosa cell tumor) → assess the endometrium pre/intraoperatively (exclude concurrent endometrial hyperplasia/cancer); androgenic features usually regress postoperatively.

Source guidelines & references

  • Ovarian sex cord-stromal tumors (NCCN/ESGO; granulosa cell tumor inhibin follow-up)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

⚠️ This pathway is for clinical reference and teaching by licensed clinicians as decision support; it does not replace clinical judgement or individualized care. In emergencies, follow resuscitation protocols first.

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Gynecology / Pelvic floorObstetric Third/Fourth-Degree Perineal Tear (OASIS) · Graded RepairSurgical approach decision / Obstetrics / Pelvic floorAcute Epidural Hematoma · Surgical Evacuation vs ObservationSurgical approach decision / Neurosurgery / TraumaAcute Subdural Hematoma · Surgical Evacuation vs ObservationSurgical approach decision / Neurosurgery / TraumaRefractory Intracranial Hypertension · Decompressive Craniectomy IndicationsSurgical approach decision / Neurosurgery / Trauma / Critical careHydrocephalus · ETV vs Ventriculoperitoneal ShuntSurgical approach decision / NeurosurgeryChiari I Malformation · Posterior Fossa Decompression IndicationsSurgical approach decision / Neurosurgery / SpineBrain Arteriovenous Malformation (AVM) · Spetzler-Martin Grade and TreatmentSurgical approach decision / Neurosurgery / InterventionalDeep Brain Stimulation (DBS) · Indications and TargetsSurgical approach decision / Neurosurgery / FunctionalCraniopharyngioma · Approach and Extent of 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Syndrome (PCS) ImagingImaging / Gynecology / InterventionalEarly Pregnancy Viability Assessment (SRU 2013)Imaging / Obstetrics and gynecology / UltrasoundEctopic Pregnancy Ultrasound DiagnosisImaging / Obstetrics and gynecology / UltrasoundIntrauterine Adhesions (Asherman) Imaging DiagnosisImaging / Gynecology / Reproductive medicineHysterosalpingography (HSG) Tubal Patency AssessmentImaging / Gynecology / Reproductive medicineGestational Trophoblastic Neoplasia (GTN) Staging and RiskImaging / Gynecologic oncologyCervical Length · Cervical Insufficiency Transvaginal UltrasoundImaging / Obstetrics / UltrasoundOvarian Vein Thrombosis (Postpartum) ImagingImaging / Obstetrics / VascularFetal Ventriculomegaly MRIImaging / Fetal medicine / Prenatal diagnosisFetal Agenesis of the Corpus Callosum MRIImaging / Fetal medicine / Prenatal diagnosisFetal Posterior Fossa Malformation MRI (Dandy-Walker Continuum)Imaging / Fetal medicine / Prenatal diagnosisCongenital Diaphragmatic Hernia (CDH) Fetal MRIImaging / Fetal medicine / Pediatric surgeryCongenital Pulmonary Airway Malformation (CPAM) Fetal · CVRImaging / Fetal medicine / Pediatric surgeryOpen Spina Bifida · Fetal Surgery Candidacy (MOMS)Imaging / Fetal medicine / Pediatric neurosurgeryDynamic Pelvic Floor MRI · Pelvic Organ Prolapse (HMO)Imaging / Gynecology / Pelvic floorCongenital Cytomegalovirus (CMV) Brain MRIImaging / Fetal medicine / Prenatal diagnosisSacrococcygeal Teratoma (Altman) Fetal MRIImaging / Fetal medicine / Pediatric surgeryFetal Neck Mass · EXIT AssessmentImaging / Fetal medicine / ENTHoloprosencephaly (HPE) Fetal MRIImaging / Fetal medicine / Prenatal diagnosisPulmonary Sequestration (BPS) Fetal MRIImaging / Fetal medicine / Pediatric surgeryFetal Lower Urinary Tract Obstruction (LUTO)Imaging / Fetal medicine / Pediatric urologyFetal Hydrops (Immune/Non-immune) Diagnostic WorkflowImaging / Fetal medicine / Maternal-fetal medicineTwin-Twin Transfusion Syndrome (TTTS · Quintero)Imaging / Fetal medicine / Maternal-fetal medicineFetal Abdominal Wall Defect (Gastroschisis vs Omphalocele)Imaging / Fetal medicine / Pediatric surgeryCongenital High Airway Obstruction (CHAOS)Imaging / Fetal medicine / ENTFetal Pleural Effusion / ChylothoraxImaging / Fetal medicine / Pediatric surgeryVein of Galen Aneurysmal Malformation (VGAM) Fetal MRIImaging / Fetal medicine / NeurointerventionFetal Malformation of Cortical Development (MCD) MRIImaging / Fetal medicine / Prenatal diagnosisFetal Microcephaly Diagnostic WorkflowImaging / Fetal medicine / Prenatal diagnosisFetal Aqueductal Stenosis (Obstructive Hydrocephalus)Imaging / Fetal medicine / Pediatric neurosurgeryFetal Intracranial Hemorrhage (IVH Grading)Imaging / Fetal medicine / Prenatal diagnosisFetal Encephalocele / Cranium BifidumImaging / Fetal medicine / Pediatric neurosurgeryFetal Tuberous Sclerosis (Rhabdomyomas + Brain Nodules)Imaging / Fetal medicine / Pediatric cardiologyFetal Abdominal Cyst Differential DiagnosisImaging / Fetal medicine / Pediatric surgeryFetal Gastrointestinal Obstruction Imaging DifferentiationImaging / Fetal medicine / Pediatric surgeryFetal Esophageal Atresia ± TEFImaging / Fetal medicine / Pediatric surgeryFetal Renal Anomaly (Cystic/Dysplastic)Imaging / Fetal medicine / Pediatric urologyFetal Skeletal Dysplasia (Lethality Prediction)Imaging / Fetal medicine / Clinical geneticsFetal Arachnoid Cyst / Midline CystImaging / Fetal medicine / Pediatric neurosurgeryFetal Hydronephrosis (UTD Classification)Imaging / Fetal medicine / Pediatric urologyFetal Adrenal/Retroperitoneal Mass DifferentiationImaging / Fetal medicine / Pediatric surgeryFetal Growth Restriction (FGR · Doppler)Imaging / Fetal medicine / Maternal-fetal medicineFetal Anemia (MCA-PSV)Imaging / Fetal medicine / Maternal-fetal medicineTwin Anemia-Polycythemia Sequence (TAPS)Imaging / Fetal medicine / Maternal-fetal medicineTwin Reversed Arterial Perfusion (TRAP · Acardiac Twin)Imaging / Fetal medicine / Maternal-fetal medicineFetal Goiter (Hypothyroid/Hyperthyroid)Imaging / Fetal medicine / Maternal-fetal medicine