Survival after an Antiangiogenetic Therapy and Surgery in a Wide Spread Growing Teratoma Originating from a Testicular Mixed Malignant Germ Cell Tumor

Abstract

Growing teratoma is still an often unsolved problem especially in male with mixed malignant GCTs of the testis or the mediastinum. This specific situation with progressive tumor growth and simultaneous normalization of tumor markers during or after treatment of malignant GCTs with teratomatous elements is judged as a fatal situation if this situation can not be controlled by extensive surgery, as teratoma are not sensible to chemotherapy or irradiation. Here, we report the case history of a 17-year old male patient with a testicular malignant GCT and wide spread lymph node metastases, who developed a rapidly progressive growing teratoma within the lymph node metastases. Within the molecular profile of the tumor we could find a cytogenetic picture typically found in malignant adult GCTs. In view of the bulky abdominal, thoracic and cervical metastases and the uncontrolled tumor progression, the situation was considered incurable. However, following an individual treatment attempt, this patient was treated with a four-agent combination of drugs with antiangiogenetic potential as well as low-dose cyclic chemotherapy. This approach resulted in a sustained disease stabilization followed by extensive surgical resection of the metastases. We therefore would like to highlight this treatment approach in unresectable growing teratoma and would like to stimulate further research and collaboration to come to an optimized treatment suggestion for this group of poor prognostic patients.

Vascularization of testicular germ cell tumours: evidence from experimental teratocarcinomas

“…More importantly, tumour growth inhibition induced by Sunitinib was also observed using a chemotherapy‐resistant choriocarcinoma cell line. Anti‐angiogenic therapy has also been successfully used in a clinical case of spread TGCT (Calaminus et al. , 2009).…”

“…More importantly, tumour growth inhibition induced by Sunitinib was also observed using a chemotherapy-resistant choriocarcinoma cell line. Anti-angiogenic therapy has also been successfully used in a clinical case of spread TGCT (Calaminus et al, 2009). As a result of metastasis, the patient was considered incurable; however, chemotherapy combined with anti-angiogenic treatment resulted in sustained disease stabilization that allowed surgical resection of the metastases.…”

Proton Beam Therapy for Loco-Regional Control of a Recurrent Mixed Malignant Germ Cell Tumor of the Skull in a 22-Month-Old Girl

“…In adolescents and young men with metastatic mixed malignant GCTs the op- posite observation can be reported [11] . After effi cient combination chemotherapy the high malignant GCT components are eliminated and widespread teratoma is remaining unresponsive to additional chemotherapy as demonstrated recently [4] . This so called growing teratoma syndrome may be life threatening if complete resection is impossible [1,11] .…”

Necrosis of a Skin Autograft After Short-Term Treatment with Sunitinib in a 14-Year-Old Girl with Metastatic Alveolar Soft Part Sarcoma of the Thigh

“…The report by Stacchiotti et al [17] prompted us to initiate sunitinib (37.5 mg daily) on a " compassionate use basis " six months after diagnosis while continuing treatment with thalidomide and peginterferon alfa-2b. A similar four-drug antiangiogenic regimen including vinblastine, thalidomide, interferon alpha-2b and bevacizumab has recently been described in a patient with metastatic growing teratoma that originated from a mixed malignant germ cell tumor of the testis [2,10] . The patient who tolerated this therapy very well achieved prolonged disease stabilization and underwent repeated surgeries to remove surgically accessible metastatic lesions.…”