YO32 - Sequelae of germ cell teratoma: Experience of two challenging clinical cases

Date 19 December 2015
Event ESMO Asia 2015
Session Poster presentation 1
Topics Germ Cell Tumours
Presenter Mukur Ray
Authors M.D. Ray, P.K. Garg
  • Surgicall Oncology, All India Institute of Medical Sciences, 110029 - Delhi/IN


Case Summary

The growing teratoma syndrome (GTS) is a rare condition seen in germ cell tumours (GCT) patients who present with progressive increasing masses during or after appropriate chemotherapy with normalized serum markers. We present two most challenging aspects of management of sequelae of germ cell teratoma - growing teratoma syndrome and transformation of teratoma into other somatic malignancies.

Case 1: An 18-years-old boy, diagnosed as a case of non-seminomatous GCT right testis Stage IIB, underwent 3cycles of BEP following orchidectomy. Post-chemotherapy CT scan revealed a 5-cm conglomerate lymph nodal mass in the aorto-caval region; IVC was compressed with abutment of 3rd part of duodenum. The patient was advised surgery. He underwent enbloc resection of the mass along with wedge resection of infiltrated duodenum.

Case 2: A 30-year-old lady presented with a progressively increasing huge abdominal mass of two to three months duration. She had been treated for malignant ovarian germ cell tumour – right oopherectomy followed by 4 cycles of systemic chemotherapy (BEP) four months ago, before she landed up to our centre with her last hope as she was declared “unresectable growing Teratoma “considering multi visceral involvements. She was explored at our centre and she underwent complete resection of the giant mass with multi-visceral resection. Post-resection, the mass weighed 17.2 kg, perhaps one of the largest reported Ovarian mass in literature.

Both the patients had unremarkable postoperative course and are well after one year of follow-up.

These two cases signify the importance of complete resection (with multi-visceral resection if required) of giant growing teratoma/somatic malignant transformation as surgery offers the only chance of cure, thereby survival. These sequelae of germ cell teratoma should not be declared ‘unresectable’ until they are explored in a high volume centre where the expert surgical and anaesthetic facilities are available