Growing teratoma syndrome after surgery for ovarian immature teratoma
1Department of Gynecologic Oncology, Kawasaki Medical School, 701-0192 Kurashiki, Okayama, Japan
2Department of Pathology, Kawasaki Medical School, 701-0192 Kurashiki, Okayama, Japan
DOI: 10.31083/j.ejgo4301017 Vol.43,Issue 1,February 2022 pp.115-122
Submitted: 20 November 2021 Accepted: 08 January 2022
Published: 15 February 2022
Growing teratoma syndrome (GTS) is a condition characterized by tumor growth during or after chemotherapy for a germ cell tumor, albeit with normal tumor marker levels in the absence of histopathological evidence of immature teratoma components. We encountered a 10-cm large GTS lesion in the para-aorti nodes after fertility-preserving surgery for a grade 3 ovarian immature teratoma. The patient was a 20 year old woman who presented to the hospital with complaints of abdominal pain and swelling. Imaging examination revealed an ovarian tumor mass measuring 24 cm in the abdominal cavity, suspected to be composed of a mixture of fat and other components. The α-fetoprotein (AFP) levels were elevated at 853 ng/mL. We elected to perform fertility-preserving surgery. The surgical findings included a tumor in the right ovary, which was excised without rupture with adnexectomy. The histopathological diagnosis was grade 3 immature teratoma. Palpation of the pelvic and para-aortic lymph node areas did not reveal significant lymphadenopathy. Subsequently, a para-aortic node metastasis (major axis: 8 cm) was discovered before chemotherapy (19 days after surgery). We confirmed that there was no swelling before surgery and assumed that the immature teratoma had recurred. Chemotherapy was initiated, and the serum AFP levels normalized after 4 courses of bleomycin, etoposide, and cisplatin (BEP) therapy. However, the para-aortic node metastasis had grown further (major axis: 10 cm). Another open surgery was performed. The nodal mass was completely excised and pathology revealed only mature teratoma. Growing teratoma syndrome should be considered in the setting of a recurrent mass with negative tumor markers.
Growing teratoma syndrome; Ovarian immature teratoma; BEP
Soichiro Suzuki,Yoshiaki Ota,Rikiya Sano,Yumiko Morimoto,Takuya Moriya,Mitsuru Shiota. Growing teratoma syndrome after surgery for ovarian immature teratoma. European Journal of Gynaecological Oncology. 2022. 43(1);115-122.
 Logothetis CJ, Samuels ML, Trindade A, Johnson DE. The growing teratoma syndrome. Cancer. 1982; 50: 1629–1635.
 Amsalem H. Growing teratoma syndrome vs. chemotherapeutic retroconversion Case report and review of the literature. Gynecologic Oncology. 2004; 92: 357–360.
 Aoki D. Annual report of Gynecologic Oncology Committee, Japan Society of Obstetrics and Gynecology, 2013. Journal of Obstetrics and Gynaecology Research. 2014; 40: 338–348.
 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. The Journal of Obstetrics and Gynaecology Research. 2011; 37: 926–932.
 Matsushita H, Arai K, Fukase M, Takayanagi T, Ikarashi H. Growing teratoma syndrome of the ovary after fertility-sparing surgery and successful pregnancy. Gynecologic and Obstetric Investigation. 2010; 69: 221–223.
 Zagamé L, Pautier P, Duvillard P, Castaigne D, Patte C, Lhommé
C. Growing teratoma syndrome after ovarian germ cell tumors. Obstetrics and Gynecology. 2006; 108: 509–514.
 Kaneko H, Somekawa Y, Kuwae C, Shida T, Kitada H, Ohotsuka
H. A case of Retroconversion of Ovarian Immature Teratoma. Tokyo Journal of Obstetrics and Gynecology. 1989; 38: 13–16.
 Miyasaka N, Kubota N, Kawamura T, Ozaki Y, Shimizu Y, Shimizu K, Aso T. A case of ovarian immature teratoma showing the retroconversion. Obstetrics and Gynecology. 1991; 58: 1395–1399.
 Nakagawa K, Iwasaki T, Okada T, Nozaki T, In K, Okumura M, Kotake Y, Yasumitu T, Katsumoto Y, Nakagawa T, Morino H, Kikui M . The Japanese Journal of Thoracic Surgery. 1991; 44: 856–859.
 Yakushiji H, Miyazaki K, Mashima H, Hisatsugu T, Sasatomi E. A case of retroconversion in metastasis of the diaphragm from ovarian immature teratoma. The Journal of the Japanese Practical Surgeon Society. 1994; 55: 1771–1774.
 Masuko Y, Arai H. A case of retroconversion in metastasis of the peritoneum and the liver from ovarian teratoma. Journal of Japan Surgical Association. 1995; 50: 665–670.
 Higaki I, Mizukami K, Hirata S, Fujimoto Y, Yamazaki O, Okuno M. A surgical case of peritoneal dissemination with retroconversion of ovarian immature teratoma. The Journal of the Japanese Practical Surgeon Society. 1997; 58: 1370–1373.
 Kobayashi J, Kobayashi M, Iwagaki H. Teratomatosis Peritonei Originated From An Immature Ovarian Teratoma-A Completely Cured Case With Six Operations. Journal of Japan Surgical Association. 1999; 60: 210–215.
 Kumagai K, Kanda K, Sato N, Iwai E, Ueki K, Terai Y, et al. A Case fo Left Ovarian Mature Cystic Teratoma Following Surgery and Chemotherapy for the Right Ovarian Immature Teratoma. The Journal of Obstetrics and Gynaecology. 2000; 52: 1717–1720.
 Sakurai Y, Miyakita M, Furukawa J, Ishikawa Y, Yoshitake A, Nishikawa M. A resected case of isolated peritoneal dissemination between the surface of liver and the diaphagma from ovarian immature teratoma. Journal of Japan Surgical Association. 2001; 56: 1125–1129.
 Itani Y, Kawa M, Toyoda S, Yamagami K, Hiraoka K. Growing teratoma syndrome after chemotherapy for a mixed germ cell tumor of the ovary. The Journal of Obstetrics and Gynaecology Research. 2002; 28: 166–171.
 Tagaya H, Kasai T, Honda T, Kobayashi Y, Hagiwara S, Komuro M, et al. A Case of Growing Teratoma Syndrome During Chemotherapy for Immature Teratome of the Ovary. Kanto Journal of Obstetrics and Gynecology. 2003; 40: 11–16.
 Rai E, Akagi T, Hayama T, Iwamoto T. Growing teratoma syndrome after chemotherapy for an immature teratoma of the right ovary. Obstetrics and Gynecology. 2004; 71: 816–820.
 Furudo T, Nagashima K, Katakiri H, Nakasato T. A case of immature teratoma with Pseudo-Meigs syndrome and Growing Teratoma syndrom. Obstetrics and Gynecology. 2004; 71: 1243–1247.
 Sunagawa M, Katoh T, Suzuki M, Shibata Y, Hiramatsu K, Shinohara T. A case of right subphrenic growing teratoma syndrome secondary to immature teratoma of the ovary. Journal of Japan Surgical Association. 2007; 68: 1816–1820.
 Totake K, Ando N, Ogawa K, Maeda O, Tokunaka M, Arakawa K, et al. A case report of growing teratoma syndrome after treatment for ovarian immature teratoma. The Kanagawa District Journal of the Japanese Obstetrical and Gynecological Society. 2011; 47: 129–132.
 Adachi K, Watanabe M, Kanayama T, Ogata S, Amemiya K, Yokoi T, et al. A case of growing teratoma syndrome managed by laparoscopic surgery. Japanese Journal of Gynecologic and Obstetric Endoscopy. 2010; 26: 370–373.
 Terada K, Yamagishi E, Kawabata I, Nakao K, Kuwabara T, Inde Y, et al. Growing Teratoma Syndrome during Chemotherapy for Immature Teratoma of the Ovary with Glimatosis Peritonei. Tokyo Journal of Obstetrics and Gynecology. 2013; 62: 76–80.
 Abe A, Utsugi K, Nomura H, Matoda M, Omatsu K, Kato K, et al. A case of ovarian growing teratoma syndrome successfully treated with laparoscopy. Japanese Journal of Gynecologic and Obstetric Endoscopy. 2012; 28: 521–525.
 Mariya T, Nishikawa A, Numata K, Kawamata A, Nihei T, Saito T. Laparoscopic Resection of Growing Teratoma Syndrome PostChemotherapy for an lmmature Ovarian Teratoma: Case Report. Japanese Journal of Gynecologic and Obstetric Endoscopy. 2013; 29: 158–162.
 Morita T, Masahiro S, Koike H, Hirano Y, Sakaguchi Y, Niguma
T. A case of growing teratoma syndrome: laparoscopic resection of primary immature teratoma. Modern Trends in Obstetrics & Gynecology. 2014; 63: 95–99.
 Imai T, Sakon H, Nishizawa C, Iidaka M, Hara Yousuke, Takata M, Mori A. A case of growing teratoma syndrome after ovarian mixed germ cell tumor. Kanto Journal of Obstetrics and Gynecology. 2014; 51: 593–596.
 Hayashi H, Taniguchi S, Kurihara S, Nakatake Y, Hachisuka K, Nakano T, et ak. A case of Growing Teratoma Syndrome Diagnosed by Laparoscopic Surgery after Chemotherapy for Malignant Ovarian Germ Cell Tumor. The Journal of the Miyazaki Medical Association. 2015; 39: 39–44.
 Sakamoto S, Hashizume N, Yagi M, Asagiri K, Fukahori S, Kojima S, et ak. Treatment of Growing Teratoma Syndrome From Ovarian and Peritoneal Disseminational Teratoma: A Case Report. Journal of the Japanese Society of Pediatric Surgeons. 2015; 51: 1214–1219.
 Ando Y, Kawashima N, Tokushige Y, Ikeda A, Takamatsu S, Murata Y, et al. A case of ovarian growing teratoma syndrome diagnosed and treated using laparoscopic surgery. Japanese Journal of Gynecologic and Obstetric Endoscopy. 2015; 31: 232–237.
 Umezu T, Osafune A, Inukai K, Mogi K, Aoki C, Yamada C, Matsui J. A case of growing teratoma syndrome managed by laparoscopic surgery 14 years after the first therapy. The Tokai Journal of Obstetrics and Gynecology. 2016; 52: 175–179.
 Kojima M, Kato A, Watanabe T, Okabe C, Sato T, Miura H, et al. A case of growing teratoma syndrome that deveroped after treatment for ovarian immature teratoma and was treated by laparoscopic surgery. Fukushima Medical Journal. 2019; 69: 7–12.
 Tanaka H, Onishi J, Goto Y, Matsuzawa S, Fuzzisaki M, Fukushima K, et al. Growing teratoma syndrome secondary to peritoneum dissemination of ovarian immature teratoma : A case report. The Journal of the Miyazaki Medical Association. 2020; 44: 25–29.
 Nakamura S, Kusumoto T, Terabayashi H, Kojima K, Funatomi S, Nishimura T, et al. A case of growing teratoma syndrome during chemotherapy for ovarian immature teratoma. Modern Trends in Obstetrics & Gynecology. 2020; 69: 101–105.
 Byrd K, Stany MP, Herbold NC, Leath CA, Hamilton CA. Growing teratoma syndrome: Brief communication and algorithm for management. The Australian & New Zealand Journal of Obstetrics & Gynaecology. 2013; 53: 318–321.
 Daher P, Riachy E, Khoury A, Raffoul L, Ghorra C, Rehayem
C. Growing teratoma syndrome: first case report in a 4-year-old girl. Journal of Pediatric and Adolescent Gynecology. 2015; 28: e5–e7.
 Djordjevic B, Euscher ED, 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. The American Journal of Surgical Pathology. 2007; 31: 1913–1918.
 Han NY, Sung DJ, Park BJ, Kim MJ, Cho SB, Kim KA, et al. Imaging features of growing teratoma syndrome following a malignant ovarian germ cell tumor. Journal of Computer Assisted Tomography. 2014; 38: 551–557.
 Hariprasad R, Kumar L, Janga D, Kumar S, Vijayaraghavan M. Growing teratoma syndrome of ovary. International Journal of Clinical Oncology. 2008; 13: 83–87.
 Kampan N, Irianta T, Djuana A, Pei Shan L, Hashim Omar M, Hatta Mohd Dali AZ. Growing teratoma syndrome: a rare case report and review of the literature. Case Reports in Obstetrics and Gynecology. 2012; 2012: 134032.
 Kato N, Uchigasaki S, Fukase M. How does secondary neoplasm arise from mature teratomas in growing teratoma syndrome of the ovary? A report of two cases. Pathology International. 2013; 63: 607–610.
 Kurata A, Hirano K, Nagane M, Fujioka Y. Immature teratoma of the ovary with distant metastases: favorable prognosis and insights into chemotherapeutic retroconversion. International Journal of Gynecological Pathology. 2010; 29: 438–444.
 Lorusso D, Malaguti P, Trivellizzi IN, Scambia G. Unusual liver locations of growing teratoma syndrome in ovarian malignant germ cell tumors. Gynecologic Oncology Case Reports. 2013; 1: 24–25.
 Morency EG, Lerner D, Garcia R, Kalir T. High-grade sarcoma masquerading as growing teratoma syndrome after resection of ovarian immature teratoma: report of a case. International Journal of Gynecological Pathology. 2012; 31: 276–279.
 Mrabti H, El Ghissassi I, Sbitti Y, Amrani M, Hachi H, Errihani
H. Growing teratoma syndrome and peritoneal gliomatosis. Case Reports in Medicine. 2011; 2011: 123527.
 Pendlebury A, Rischin D, Ireland-Jenkin K, Toner GC, Grant
P. Ovarian Growing Teratoma Syndrome with Spuriously El-evated α-Fetoprotein. Journal of Clinical Oncology. 2014; 33: e99–100.
 Rashmi, Radhakrishnan G, Radhika AG, Sharma S. Growing teratoma syndrome: a rare complication of germ cell tumors. Indian Journal of Cancer. 2010; 47: 486–487.
 Sengar AR, Kulkarni JN. Growing teratoma syndrome in a post laparoscopic excision of ovarian immature teratoma. Journal of Gynecologic Oncology. 2010; 21: 129–131.
 Tangjitgamol S, Manusirivithaya S, Leelahakorn S, Thawara-mara T, Suekwatana P, Sheanakul C. The growing teratoma syndrome: a case report and review of the literature. International Journal of Gynecological Cancer. 2006; 16: 384–390.
 Tejura H, O’Leary A. Growing teratoma syndrome after chemotherapy for germ cell tumour of the ovary. Journal of Obstetrics and Gynaecology. 2005; 25: 296–297.
 Tzortzatos G, Sioutas A, Schedvins K. Successful pregnancy after treatment for ovarian malignant teratoma with growing teratoma syndrome. Fertility and Sterility. 2009; 91: 936.e1–
 Meistrich ML, Shetty G. Hormonal suppression for fertility preservation in males and female. Reproduction. 2008; 136: 691–701.
 Blumenfeld Z. GnRH-agonists in fertility preservation. Current Opinion in Endocrinology, Diabetes, and Obesity. 2008; 15: 523–528.
 Weinberg LE, Lurain JR, Singh DK, Schink JC. Survival and reproductive outcomes in women treated for malignant ovarian germ cell tumors. Gynecologic Oncology. 2011; 121: 285–289.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.
Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.
JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.
Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.
BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.