Patients and referring physicians around the world have turned to OSO since 1997.
Affiliates of the Mass General Brigham system include Harvard Medical School teaching hospitals.
The Mass General Brigham doctors providing second opinions are leaders in medicine, research and training.
Identifying the most appropriate expert specialists in our network to comment on particular diagnoses
Conducting imaging and biopsy reviews to affirm, adjust or change original diagnoses
Confirming treatment plans, therapies and interventions—or recommending alternatives
Providing guidance on medication management and pain management strategies
With OSO, your patient can avoid the time and expense of traveling to receive the very best specialty consultation.
Plus, you will both have the confidence that comes with our diagnosis and treatment plan reviews, thus avoiding unnecessary testing and procedures.
This is the base cost for a medical second opinion. We encourage you and your patient to provide specific questions that you would like the reviewing doctor to address in the consultation letter. Doing so is helpful to the reviewing doctor and ensures you receive useful input and recommendations. Please note: There is an additional fee if an imaging and/or biopsy review is requested, more than four questions are included for the reviewing physician or the patient uses the Health Advocate medical record collection service. See below for details.
An imaging review involves an interpretation of imaging examinations, such as computed tomography (CT or CAT) scans or magnetic resonance imaging (MRI) scans. Pricing depends on how many different parts of the body are being reviewed. Each imaging site is considered a separate study.
A biopsy review involves an interpretation of pathological specimens, which may take the form of slides or blocks. Pricing depends on how many different parts of the body are being reviewed. Each biopsy site is considered a separate study. Please note: There is an additional fee for reviews of blocks or unstained slides, or if special staining of slides is required for interpretation.
In order to make the consultation process as easy as possible for your patient, we have partnered with Health Advocate. This third-party service will manage the collection and submission of all medical records and test results required for the second opinion.
Posting more than four questions (including multi-part questions) in your request will incur an additional fee. Clarification questions are allowed after a consultation, but there is an additional fee for follow-up questions.
Also, the following fees apply for medical records with more than 50 pages:
|51 - 75||$25|
|76 - 100||$50|
|101 - 125||$75|
|126 - 150||$100|
|151 - 175||$125|
|176 - 200||$150|
|201+||Contact us to discuss|
If you have any questions about costs, please contact us at firstname.lastname@example.org.
Dear Dr. XX:
Thank you for referring Ms. Female Patient to Online Second Opinions.(1)
The patient is a 51-year-old with a history of uterine myomas (fibroids), presenting with abdominal discomfort. She has undergone imaging by both pelvic ultrasound and MRI and has been recommended surgery for possible uterine sarcoma. I am not able to offer an opinion on the imaging given that it is outside my scope of practice as a gynecologic oncologist and I am not a radiologist. My opinion is based on the available ultrasound report enclosed with the documents available for my review.(2)
Uterine sarcoma accounts for 3 to 9 percent of all uterine malignant neoplasms. Uterine sarcomas arise from dividing cell populations in the myometrium or connective tissue elements within the endometrium. Compared with the more common endometrial carcinomas (epithelial neoplasms), uterine sarcomas, particularly leiomyosarcomas (connective tissue neoplasms), behave aggressively and are associated with a poorer prognosis.(3)
Risk factors for uterine sarcoma include: black race (for leiomyosarcoma, but not endometrial stromal sarcoma), long-term use of tamoxifen (five years or more), and pelvic radiation. Genetic conditions associated with uterine sarcoma are hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome and hereditary childhood retinoblastoma. Uterine sarcomas typically present with vaginal bleeding, pelvic pressure symptoms (eg, pressure, urinary frequency, constipation), or abdominal distension. On pelvic examination, the uterus is often enlarged.
The findings on examination and imaging for uterine sarcoma are nearly identical to those for benign uterine leiomyomas, as well as for atypical leiomyoma variants. Thus, the diagnosis of uterine sarcoma is often made after myomectomy or hysterectomy. That is, there is no way to make a definitive diagnosis of this highly malignant tumor other than by surgical removal of the “fibroid” or by removal of the uterus. Unfortunately, imaging studies cannot reliably differentiate between a uterine sarcoma and other uterine findings (eg, leiomyomas, adenomyosis). The diagnosis of uterine sarcoma is based upon histologic examination. Data regarding diagnostic accuracy of serum markers, biopsy, or imaging are limited in this rare disease.(4)
Thus, given the concern for a sarcoma raised by the ultrasound and the fact that it is not medically possible to make a definitive diagnosis of sarcoma without surgical tissue, I agree with the recommendation for surgery and would recommend a total hysterectomy and removal of both ovaries and fallopian tubes given that the area of concern extends to the adnexal region, which would also include the ovaries and the fallopian tubes. The operation should be done so as to allow removal of all of these structures as a whole, without morcellating or cutting the tissue. The choice of treatment after surgery depends entirely on the final pathology. There are data to support use of chemotherapy in the setting of advanced-stage leiomysarcoma but the final recommendation regarding post operative treatment is entirely dependent on the surgical histologic findings.(5)
1. Nordal RR, Thoresen SO. Uterine sarcomas in Norway 1956-1992: incidence, survival and mortality. Eur J Cancer 1997; 33:907.
2. Tropé CG, Abeler VM, Kristensen GB. Diagnosis and treatment of sarcoma of the uterus. A review. Acta Oncol 2012; 51:694.
3. Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol 1994; 18:535.
4. Silverberg SG, Kurman RJ. Tumors of the uterine corpus and gestational trophoblastic disease. In: Atlas of Tumor Pathology - Armed Forces Institute of Pathology, electronic fascicle version 2.0, Washington DC.
5. Kurma RJ. Pathology of the Female Genital Tract, 4th, Springer Verlag, New York p.499.
6. Sandberg AA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: leiomyosarcoma. Cancer Genet Cytogenet 2005; 161:1.
7. Sandberg AA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: leiomyoma. Cancer Genet Cytogenet 2005; 158:1.
8. Morton CC. Genetic approaches to the study of uterine leiomyomata. Environ Health Perspect 2000; 108 Suppl 5:775.
9. Bodner K, Bodner-Adler B, Kimberger O, et al. Estrogen and progesterone receptor expression in patients with uterine leiomyosarcoma and correlation with different clinicopathological parameters. Anticancer Res 2003; 23:729.
10. Wade K, Quinn MA, Hammond I, et al. Uterine sarcoma: steroid receptors and response to hormonal therapy. Gynecol Oncol 1990; 39:364.
11. Moinfar F, Azodi M, Tavassoli FA. Uterine sarcomas. Pathology 2007; 39:55.
12. Karpathiou G, Sivridis E, Giatromanolaki A. Myxoid leiomyosarcoma of the uterus: a diagnostic challenge. Eur J Gynaecol Oncol 2010; 31:446.
13. Oliva E, Clement PB, Young RH, Scully RE. Mixed endometrial stromal and smooth muscle tumors of the uterus: a clinicopathologic study of 15 cases. Am J Surg Pathol 1998; 22:997.
14. Kir G, Gurbuz A, Karateke A, Dayicioglu V. Stromomyomas of the uterus-- importance of total circumferential evaluation of the margin. Eur J Gynaecol Oncol 2004; 25:489.
15. Clement PB, Scully RE. Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature. Hum Pathol 1990; 21:363.
16. Krivak TC, Seidman JD, McBroom JW, et al. Uterine adenosarcoma with sarcomatous overgrowth versus uterine carcinosarcoma: comparison of treatment and survival. Gynecol Oncol 2001; 83:89.
17. Toro JR, Travis LB, Wu HJ, et al. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978-2001: An analysis of 26,758 cases. Int J Cancer 2006; 119:2922.
18. Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989-1999. Gynecol Oncol 2004; 93:204.
19. Ueda SM, Kapp DS, Cheung MK, et al. Trends in demographic and clinical characteristics in women diagnosed with corpus cancer and their potential impact on the increasing number of deaths. Am J Obstet Gynecol 2008; 198:218.e1.
20. Norris HJ, Taylor HB. Mesenchymal tumors of the uterus. I. A clinical and pathological study of 53 endometrial stromal tumors. Cancer 1966; 19:755.
21. Sherman ME, Devesa SS. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer 2003; 98:176.
22. Mourits MJ, De Vries EG, Willemse PH, et al. Tamoxifen treatment and gynecologic side effects: a review. Obstet Gynecol 2001; 97:855.
23. Yildirim Y, Inal MM, Sanci M, et al. Development of uterine sarcoma after tamoxifen treatment for breast cancer: report of four cases. Int J Gynecol Cancer 2005; 15:1239.
24. Wysowski DK, Honig SF, Beitz J. Uterine sarcoma associated with tamoxifen use. N Engl J Med 2002; 346:1832.
25. Wickerham DL, Fisher B, Wolmark N, et al. Association of tamoxifen and uterine sarcoma. J Clin Oncol 2002; 20:2758.
"This service is a lifesaver. We do not have a sarcoma center in our state. The information provided by your specialist gave me the strength and further support to approach an oncologist in our state to insist on the proper treatments. Thank you!"
"Your service was wonderful. The staff's follow-up and follow-through were far superior than what my family received from any facility local to our home. Though the outcome was not good for my father, your superb professionalism and attention to detail were far superior to the care my father had received elsewhere."
"It was a great experience. I know that Dana-Farber doctors are the best in the country, but I was unable to travel to Boston for a consultation. We feel much better having our doctor's diagnosis confirmed."
"I wanted an outside-looking-in opinion to confirm what my son's local neurologists had already determined — that he would not be an ideal candidate for brain surgery. The service was outstanding, and the quality of the opinion was exceptional. I was able to help drive the process along despite being out of the physician-to-physician privy. It meant the world to me to not be completely shut out of the process. I wouldn't hesitate to use this service again."
"I did the online consultation because of the drugs that my doctor was recommending as my next course of treatment. The side effects are quite harsh, and I wanted to find out if there were other treatment options available to me. I was very pleased with the results of the consultation in that it both confirmed the treatment proposed and gave me more options."
Yes. Your participation is a legal requirement for a variety of reasons. For example, Online Second Opinions (OSO) must adhere to Health Insurance Portability and Accountability Act (HIPAA) rules and state licensure laws, all of which are designed to protect patient privacy. Also, many of the reports written by our specialists contain medical terminology, so it is important that you first review the second opinion and then discuss its content with your patient.
Our team includes case coordinators with years of experience recruiting and working with physicians at all Mass General Brigham hospitals. They call on their experience to identify the best qualified specialist based on your patient’s medical situation and the questions that you and your patient submit.
Please refer to the website of the physician’s hospital to view his or her profile.
The first step is to register as a referring physician. See this page for more details.
While we make every effort to accommodate requests in these cases, we cannot guarantee that a particular doctor will be available to review your patient’s records. Regardless of which doctor reviews your patient’s case, you can be confident that he or she has highly specialized expertise.
In this case, having patient records professionally translated helps our specialists provide the most accurate and relevant information possible in their reports. While we do not endorse any particular translation companies, we have had good results with Interpreters Associates Inc. (www.interpretersassociates.com or www.interpretersbrazil.com).
You and your patient may submit up to four questions; any further questions will incur an additional fee. Visit this page for more details.
Please refer to our Consultation Guidelines (PDF) for details.
You can share records and imaging/biopsy materials with OSO in a variety of ways.
Electronic options include:
Our specialists typically complete a second opinion within 10 business days. Our case coordinators will keep you and your patient updated on the status of the consult throughout the process.
Please visit this page for details.
Health Advocate, a third-party service that is available to your patient for an additional fee, can manage the collection and submission of all medical records and test results required for a second opinion.
Mass General Brigham is a not-for-profit healthcare delivery network based in Boston, Massachusetts. Member institutions include prestigious Harvard Medical School teaching hospitals, including Brigham & Women's Hospital and Massachusetts General Hospital, which co-founded Mass General Brigham in 1994.