Growing teratoma syndrome in a post laparoscopic excision of ovarian immature teratoma

Abstract

A 26-year-old girl was referred to us in December 2008 with progressive pelvic mass while on chemotherapy. In May 2008, she presented with large adnexal mass and high alpha-fetoprotein (AFP, 265.7 ng/mL; normal range, 0 to 10). She underwent laparoscopic right salpingo-oophorectomy with staging. Since histology was immature teratoma grade I, FIGO stage 1 she was kept on surveillance. In September 2008, she developed recurrent pelvic mass with AFP levels of 2,400 ng/mL. Three courses of chemotherapy (bleomycin-etoposide-cisplatin) were given. Post-chemotherapy AFP normalized but tumor size increased. CT-scan (abdomen-pelvis) showed a large pelvic mass with calcification specks; infiltrating the sigmoid colon and abdominal wall. With provisional diagnosis of growing teratoma syndrome she had exploratory laparotomy with excision of pelvic mass along with sigmoid colon, excision of right pelvic and subcutaneous deposits, omentectomy and sigmoid anastomosis. Left ovary, left tube and uterus appeared normal and were preserved. Histology of all masses showed mature teratoma, no immature elements. At six months follow up she is disease free and has resumed menstruation. Growing teratoma syndrome is a clinico-pathological presentation during/post-chemotherapy in malignant ovarian germ cell tumor where mature teratoma grows and requires complete surgical excision. Our case highlights the safety and adequacy concerns of laparoscopic management of malignant ovarian tumor. Literature review suggests good prospects of resumption of menses, child bearing and five year survival in case of growing teratoma syndrome.

Growing Teratoma Syndrome

“…There is only 1 previous report of a patient developing GTS after pregnancy, 8 yr after treatment of her immature ovarian teratoma (21). We are aware of only 2 reports of successful pregnancy after treatment of GTS (29,30). The second patient in the present report is still undergoing treatment for infertility over 10 yr after the primary diagnosis.…”

An ultralate female growing teratoma syndrome: 19 years after aggressive treatment for advanced ovarian immature teratoma

“…The median age at diagnosis of GCT ranges from 22 to 26 years. [ 1 2 3 ] We reviewed the literature of ovarian GTS reported in the last decade [ Table1 ]. The etiology, pathogenesis, and risk factor remain unclear.…”

Growing Teratoma Syndrome

“…Both laparotomy and laparoscopic approach are advisable to reduce tumor bulk. Laparoscopy is associated with less postoperative complications but port-site recurrence is well documented [24]. Late surgery may lead to increased tumor size leading to mechanical compression of vital organs leading renal dysfunction because of ureteral compression, bowel ischemia, and biliary obstruction.…”