Pediatric Ovarian Growing Teratoma Syndrome

Abstract

Ovarian immature teratoma is a germ cell tumor that comprises less than 1% of ovarian cancers and is treated with surgical debulking and chemotherapy depending on stage. Growing teratoma syndrome (GTS) is the phenomenon of the growth of mature teratoma elements with normal tumor markers during or following chemotherapy for treatment of a malignant germ cell tumor. These tumors are associated with significant morbidity and mortality due to invasive and compressive growth as well as potential for malignant transformation. Current treatment modality is surgical resection. We discuss a 12-year-old female who presented following resection of a pure ovarian immature teratoma (grade 3, FIGO stage IIIC). Following chemotherapy and resection of a pelvic/liver recurrence demonstrating mature teratoma, she underwent molecular genetics based chemotherapeutic treatment. No standardized management protocol has been established for the treatment of GTS. The effect of chemotherapeutic agents for decreasing the volume of and prevention of expansion is unknown. We review in detail the history, diagnostic algorithm, and previous reported pediatric cases as well as treatment options for pediatric patients with GTS.

A case series and literature review on 98 pediatric patients of germ cell tumor developing growing teratoma syndrome

“…A PubMed search with “growing teratoma syndrome” returned 190 articles, and 43 of them were eligible 5,8–49 . In total, 93 identified patients from the literature review and our five patients were enrolled in the present study (Figure 1).…”

“…A PubMed search with “growing teratoma syndrome” returned 190 articles, and 43 of them were eligible. 5 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 In total, 93 identified patients from the literature review and our five patients were enrolled in the present study (Figure 1 ). Of these patients, 46 (47%) had extracranial GCTs (21 with eMGCTs and 25 with eITs), and 52 (53%) had intracranial GCTs (41 with iMGCTs and 11 with iITs).…”

“…A regimen of temozolomide 40 mg/m PO daily (days 1–28), tretinoin 25 mg/m/day PO BID (days 1–14), and sorafenib 150 mg/m 2 PO BID (days 1–28), with the addition of thalidomide from the second cycle was given to a 12‐year‐old girl with a grade 3 FIGO stage IIIC immature teratoma in the right ovary and incomplete resection of GTS in the abdomen, pelvis, and chest. She had stable disease for 4 months on the preceding regimen 44 . Stabilization of extracranial GTS in three men, aged 22–37 years, was observed with the use of palbociclib, a selective inhibitor of the cyclin‐dependent kinases CDK4 and CDK6 56 .…”

“…She had stable disease for 4 months on the preceding regimen. 44 Stabilization of extracranial GTS in three men, aged 22–37 years, was observed with the use of palbociclib, a selective inhibitor of the cyclin‐dependent kinases CDK4 and CDK6. 56 Schultz et al 12 adopted palbociclib to treat intracranial GTS progression of a 5‐year‐old child with pineal GCT after incomplete resection of GTS.…”

Teratoma ovárico: reporte de un caso en población pediátrica

“…Su diagnóstico confirmatorio y etiológico se realiza mediante estudio anatomo-patológico, tras la resección quirúrgica o cuando se indique la toma de biopsia con aguja fina ecoguiada. En pediatría los tumores de origen maligno son muy escasos y tienen una clínica inespecífica, sin embargo; no se puede dejar pasar por desapercibido a estos por lo que su diagnóstico precoz nos ayudará a una terapéutica adecuada, ya que el manejo posterior dependerá del tipo de tumor y extensión de este (Alá Paredes & Cañedo García, 2013;Rentea et al, 2017). En cuanto al tratamiento la cirugía conservadora, abierta o laparoscópica, debe ser la primera opción terapéutica, donde se puede extirpar la masa completa o mas del 90% de la misma; en caso de confirmarse un tumor maligno, se dará sesiones de quimioterapia reductora y posteriormente se programará la exéresis del tumor con la finalidad de conservar las funciones hormonales y reproductivas futuras (García-Verdugo et al, 2020).…”