Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2022; 32(03): 301-307
DOI: 10.1055/s-0042-1744519
Original Article

Growing Teratoma Syndrome—A Clinicoradiological Series

Sheena Prineethi
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Aparna Irodi
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Anu Eapen
1   Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
,
Sharon Milton
2   Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
,
Anjana Joel
3   Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

Abstract

Context Growing teratoma syndrome (GTS) is a rare entity seen following chemotherapy for metastatic nonseminomatous germ cell tumors, characterized by increase in size of the metastatic deposits, with normal serum tumor markers.

Aims In this article, we aim to describe the various clinicoradiological presentations of GTS treated at our center.

Design All patients who satisfied the GTS criteria from 2001 to 2019 were included. Characteristic imaging appearances along with sites of primary lesion and metastatic disease, stage and risk stratification at diagnosis, details of chemotherapy, details of surgical treatment and histopathology, levels of tumor markers, serum β-human chorionic gonadotropin, lactate dehydrogenase, and alpha fetoprotein levels at baseline and at the end of all chemotherapy were analyzed.

Results The significant radiological findings observed were an increase in the fat and cystic components and appearance of coarse calcifications within the lesions. Majority of the cases were male patients (87.5%) with testicular primaries and GTS transformation in nodal metastases being the most common occurrence (75%). All eight cases (100%) showed an increase in size and cystic component, whereas four out of eight cases (50%) had presence of internal septations and internal calcification.

Conclusion Early recognition of this entity and clinical decision making through serial radiological imaging are of utmost importance as these growing deposits are resistant to chemotherapy and radiotherapy, with complete surgical excision being the only curative and definitive treatment option.

Keywords

growing teratoma syndrome - germ cell tumor - nonseminomatous germ cell tumor - mature teratoma - chemotherapy


Publication History

Article published online:
17 August 2022

© 2022. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Tangjitgamol S, Manusirivithaya S, Leelahakorn S, Thawaramara T, Suekwatana P, Sheanakul C. The growing teratoma syndrome: a case report and a review of the literature. Int J Gynecol Cancer 2006; 16 (Suppl. 01) 384-390
    CrossrefPubMedSearch in Google Scholar
  • 2 Gorbatiy V, Spiess PE, Pisters LL. The growing teratoma syndrome: current review of the literature. Indian J Urol 2009; 25 (02) 186-189
    CrossrefPubMedSearch in Google Scholar
  • 3 Diong NC, Dharmaraj B, Joseph CT, Sathiamurthy N. Growing teratoma syndrome of mediastinal nonseminomatous germ cell tumor. Ann Thorac Med 2020; 15 (01) 38-40
    CrossrefPubMedSearch in Google Scholar
  • 4 Logothetis CJ, Samuels ML, Trindade A, Johnson DE. The growing teratoma syndrome. Cancer 1982; 50 (08) 1629-1635
    CrossrefPubMedSearch in Google Scholar
  • 5 Spiess PE, Kassouf W, Brown GA. et al. Surgical management of growing teratoma syndrome: the M. D. Anderson cancer center experience. J Urol 2007; 177 (04) 1330-1334 , discussion 1334
    CrossrefPubMedSearch in Google Scholar
  • 6 André F, Fizazi K, Culine S. et al. The growing teratoma syndrome: results of therapy and long-term follow-up of 33 patients. Eur J Cancer 2000; 36 (11) 1389-1394
    CrossrefPubMedSearch in Google Scholar
  • 7 DiSaia PJ, Saltz A, Kagan AR, Morrow CP. Chemotherapeutic retroconversion of immature teratoma of the ovary. Obstet Gynecol 1977; 49 (03) 346-350
    PubMedSearch in Google Scholar
  • 8 Smithers DW. Maturation in human tumours. Lancet 1969; 2 (7627): 949-952
    CrossrefPubMedSearch in Google Scholar
  • 9 Merrin C, Baumgartner G, Wajsman Z. Letter: Benign transformation of testicular carcinoma by chemotherapy. Lancet 1975; 1 (7897): 43-44
    CrossrefPubMedSearch in Google Scholar
  • 10 Willis GW, Hajdu SI. Histologically benign teratoid metastasis of testicular embryonal carcinoma: report of five cases. Am J Clin Pathol 1973; 59 (03) 338-343
    CrossrefPubMedSearch in Google Scholar
  • 11 Cheng L, Albers P, Berney DM. et al. Testicular cancer. Nat Rev Dis Primers 2018; 4 (01) 29
    CrossrefPubMedSearch in Google Scholar
  • 12 Veneris JT, Mahajan P, Frazier AL. Contemporary management of ovarian germ cell tumors and remaining controversies. Gynecol Oncol 2020; 158 (02) 467-475
    CrossrefPubMedSearch in Google Scholar
  • 13 Stram AR, Kesler KA. Mediastinal germ cell tumors: updates in diagnosis and management. Surg Oncol Clin N Am 2020; 29 (04) 571-579
    CrossrefPubMedSearch in Google Scholar
  • 14 Maroto P, Tabernero JM, Villavicencio H. et al. Growing teratoma syndrome: experience of a single institution. Eur Urol 1997; 32 (03) 305-309
    CrossrefPubMedSearch in Google Scholar
  • 15 Lee DJ, Djaladat H, Tadros NN. et al. Growing teratoma syndrome: clinical and radiographic characteristics. Int J Urol 2014; 21 (09) 905-908
    CrossrefPubMedSearch in Google Scholar
  • 16 Han NY, Sung DJ, Park BJ. et al. Imaging features of growing teratoma syndrome following a malignant ovarian germ cell tumor. J Comput Assist Tomogr 2014; 38 (04) 551-557
    CrossrefPubMedSearch in Google Scholar
  • 17 Saso S, Galazis N, Iacovou C. et al. Managing growing teratoma syndrome: new insights and clinical applications. Future Sci OA 2019; 5 (09) FSO419
    CrossrefPubMedSearch in Google Scholar
  • 18 Aide N, Comoz F, Sevin E. Enlarging residual mass after treatment of a nonseminomatous germ cell tumor: growing teratoma syndrome or cancer recurrence?. J Clin Oncol 2007; 25 (28) 4494-4496
    CrossrefPubMedSearch in Google Scholar
  • 19 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. Am J Surg Pathol 2007; 31 (12) 1913-1918
    CrossrefPubMedSearch in Google Scholar
  • 20 Kesler KA, Patel JB, Kruter LE. et al. The “growing teratoma syndrome” in primary mediastinal nonseminomatous germ cell tumors: criteria based on current practice. J Thorac Cardiovasc Surg 2012; 144 (02) 438-443
    CrossrefPubMedSearch in Google Scholar
  • 21 Kattan J, Droz JP, Culine S, Duvillard P, Thiellet A, Peillon C. The growing teratoma syndrome: a woman with nonseminomatous germ cell tumor of the ovary. Gynecol Oncol 1993; 49 (03) 395-399
    CrossrefPubMedSearch in Google Scholar
  • 22 Saju SV, Radhakrishnan V, Ganesan TS. et al. Factors that impact the outcomes in testicular germ cell tumors in low-middle-income countries. Med Oncol 2019; 36 (03) 28
    CrossrefPubMedSearch in Google Scholar