Liver transplantation for growing teratoma syndrome: Report of a case

Abstract

Liver transplantation is a well-established treatment for liver failure and for a selected group of patients with hepatic tumors. The growing teratoma syndrome refers to the phenomenon whereby germ cell tumors enlarge after chemotherapy despite complete eradication of malignant cells and normalization of serum tumor markers. We present the case of a young patient with rapidly growing teratomatous masses in his liver who was treated with liver transplantation from a live donor. We discuss his postoperative management, follow-up, and briefly review literature on the subject. (Liver Transpl 2003;9:1222-1224.)T he growing teratoma syndrome (GTS) is characterized by the enlargement of mixed nonseminomatous germ cell tumors (NSGCTs) after successful chemotherapy with normalization of tumor marker values. 1,2 This syndrome includes patients with enlarging masses in the retroperitoneum or mediastinum and, rarely, liver containing mature teratoma cells. Despite their benign nature, continuous growth of these tumors can potentially cause significant morbidity and possible mortality secondary to their encroachment on adjacent structures in the chest or abdomen. Radical surgical excision of tumors is the only curative option.Involvement of the liver by NSGCTs and transformation to GTS, although rare, has been reported. 3,4 Unfortunately, because of the diffuse involvement of the liver, in some cases, liver resection and other recent modalities for treatment of hepatic tumors are not effective. Liver transplantation (LT) may be the only option with potential for cure in these patients. We report the first case of LT for GTS. Case ReportA 22-year-old man initially presented with a right testicular mass, which he had ignored for 6 months, followed by increasing abdominal girth, right upper-quadrant fullness, and a more than 30-pound weight loss. At evaluation, he was found to have a large testicular mass, as well as multiple metastatic deposits in the liver, hydronephrosis in the right kidney, and retroperitoneal adenopathy with moderate ascites on an abdominal computed tomographic (CT) scan.At presentation serum, alpha-fetoprotein level was 18,300 ng/mL (normal, 0 to 15 ng/mL), and ␤-human chorionic gonadotropin level was 3,840 MIU/mL (normal, 0 to 5 MIU/ mL). The patient underwent a right radical orchiectomy. A pathological diagnosis of mixed germ cell tumor (embryonal carcinoma, 50%; yolk sac tumor, 30%; immature teratoma, 10%; and seminoma, 10%) was established. There was extratesticular extension of the tumor with invasion of the epididymis and focal lymphovascular invasion with negative resection margin. The patient was started on a cisplatin-based chemotherapeutic regimen. After 4 months, the patient underwent retroperitoneal lymphadenectomy, right nephrectomy, and liver biopsy. The specimens showed residual mature teratoma cells without evidence of malignant components in any resected tissue. The patient continued to undergo chemotherapy for another 4 months. Serum tumor marker levels stayed normal, but the hepatic les...

Rare primary mature teratoma of the liver: A case report

“…However, the liver teratomas continued to grow, confirming the GTS diagnosis, and patients were accepted for liver transplantation (LT). After LT, there was no evidence of teratoma recurrence[ 24 , 25 ]. O’Reilly et al [ 22 ] presented the first case of GTS in a primary liver teratoma in a 22 years old female.…”