Growing teratoma syndrome after chemotherapy for a mixed germ cell tumor of the ovary

Abstract

A retroperitoneal enlarging mass was detected and resected in a 24-year-old nulliparous woman after fertility-preserving surgery and adjuvant chemotherapy for a malignant germ cell tumor (MGCT) of the right ovary. This enlarging mass contained only a mature teratoma component. Alpha-fetoprotein, which was elevated to 21236.6 ng/mL before the initial surgery, persisted within normal after the completion of adjuvant platinum-based chemotherapy. The patient was diagnosed with growing teratoma syndrome. Growing teratoma syndrome originating from ovarian germ cell tumor is very rare. Only 15 cases have been reported. Surgical resection and histological confirmation of growing mass after MGCT treatment is essential before conducting salvage chemotherapy.

Surgical Outcomes After Debulking Surgery for Intraabdominal Ovarian Growing Teratoma Syndrome: Analysis of 38 Cases

“…16 Except for a short series of 12 cases (none of them treated surgically) dedicated to oncologic issues, most publications about GTS in women are case reports (reporting 1-3 cases). 6,15,25,26,29 We present the largest series of GTS occurring after treatment for ovarian germ cell tumors and the first series specifically dedicated to surgical considerations.…”

“…[18][19][20][21][22] In contrast, GTS after ovarian immature teratoma can either have a retroperitoneal nodal spread or present with diffuse peritoneal disease, similar to other ovarian malignancies. [23][24][25][26][27][28][29] The proposed surgery usually is a so-called ''debulking'' surgery, a term conventionally used for the removal of the intraabdominal tumor in ovarian cancer, However, the literature has little data regarding the extent of surgery required, particularly the place of fertilitysparing surgery or the clinical outcome after debulking for intraabdominal GTS. Because GTS is significantly less frequent in women than in men, published series are short, and none have focused specifically on the question of surgical management and postsurgical outcomes.…”

Unusual liver locations of growing teratoma syndrome in ovarian malignant germ cell tumors

“…DiSaia et al (1977) were the first to describe this phenomenon as "chemotherapeutic retroconversion." Logothetis et al (Itani et al, 2002) observed similar clinical progression in males with germ cell tumor of testis and coined the term"growing teratoma syndrome." Aronowitz et al (DiSaia et al, 1977) describe this phenomenon in women.…”

“…The possible pathogenesis of GTS development is either a malignant cell differentiation into mature teratoma or a selective chemotherapy induced destruction of immature elements. Complete surgical excision is required to avoid compressive effects (Itani et al, 2002), the risk of rupturing, displacement of adjacent organs and potential malignant transformation into either sarcoma or carcinoma which is reported in 3% of cases. The prognosis is excellent and only few cases of deaths are reported in literature.…”

“…In 1993 Kattan et al described the case of a woman with GTS in which peritoneal nodules secondary infiltrating the liver parenchyma and causing small bowel necrosis and urinary tract obstruction appeared during chemotherapy treatment for MGCT. We describe the first two reported cases of GTS with liver locations occurring after fertility sparing surgery and chemotherapy in two ovarian MGCTs (Tewari et al, 2000;Geisler et al, 1994;DiSaia et al, 1977;Itani et al, 2002).…”