Growing teratoma syndrome: an unusual evolution of treated ovarian immature teratoma - a case report

Growing teratoma syndrome (GTS) is a rare condition among germ cell tumor (GCT) patients during treatment with systemic chemotherapy. It is characterized by the development of enlarging masses, the normalization of tumor markers, and the presence of only mature teratoma in the pathological specimen. The authors present the unusual case of a 15-year-old girl with an immature teratoma treated with conventional surgery and systemic chemotherapy. On her follow up, although tumor markers returned to normal, there was an enlargement of abdomino-pelvic masses confirmed by a PET/TC study. With the diagnosis of a GTS, the patient underwent a complete cytoreduction. Histologically, all the specimens contained mature teratoma tissue. The patient remains clear with no signs of recurrence with no further treatment. The knowledge and awareness of this syndrome are highlighted in order to prevent further unnecessary chemotherapy and allow an optimal cytoreduction, which seems to be the most effective therapy so far

Growing teratoma syndrome; Germ cell tumors; Immature teratoma; Chemotherapeutic retroconversion; Ovarian neoplasms.

[1] DiSaia P.J., Saltz A., Kagan A.R., Morrow C.P.: “Chemotherapeutic retroconversion of immature teratoma of the ovary”. Obstet. Gynecol., 1977, 49, 346.

[2] Logothetis C.J., Samuels M.L., Trindade A., Johnson D.E.: “The growing teratoma syndrome”. Cancer, 1982, 50, 1629.

[3] Djordjevic B., Euscher E.D., Malpica A.: “Growing teratoma syndrome of the ovary: review of literature and first report of a carcinoid tumor arising in a growing teratoma of the ovary”. Am. J. Surg. Pathol., 2007, 31, 1913.

[4] Kikawa S., Todo Y., Minobe S., Yamashiro K., Kato H., Sakuragi N.: “Growing teratoma syndrome of the Ovary: A case report with FDG -PET findings.2J”. Obstet. Gynaecol. Res., 2011, 37, 926.

[5] Byrd K., Stany M.P., Herbold N.C., Leath Ch.A. III, Hamilton Ch.A.: “Growing teratoma syndrome: brief communication and algorithm for management. A.N.Z.J.O.G., 2013, 53, 318.

[6] Gatcombe H.G., Aassikis V., Kooby D., Johnstone P.A.S.: “Primary retroperitoneal teratomas: a review of the literature”. J. Surg.Oncol., 2004, 86, 107.

[7] Amsalem H., Nadjari M., Prus D., Hiller N., Benshushan A.: “Growing teratoma syndrome vs chemotherapeutic retroconversion: case report and review of the literature”. Gynecol. Oncol., 2004, 92, 357.

[8] Han N.Y., Sung, D.J., Park B.J., Kim MJ, Cho SB, Kim KA, SongJY.: “Imaging features of growing teratoma syndrome follo wing a malignant ovarian germ cell tumor”. J. Comput. Assist. Tomogr., 2014, 38, 551.