Growing Teratoma Syndrome A Rare Case Report

Introduction - Growing teratoma syndrome (GTS) refers to metastatic masses from non-seminomatous germ cell tumors (NSGCT) containing mature teratoma, enlarging during or after chemotherapy. Surgery is the only chance of cure for these patients and is often difficult. Early exploration optimizes the chance of complete resection which is necessary for long term survival. Case report - We report a case of growing teratoma syndrome in a 24 year old male who had underwent orchiectomy for NSGCT in the right undescended intraabdominal testis in a private hospital in january 2010 after which he received 4 cycles of BEP (Bleomycin-EtoposideCisplatin) and 2 cycles of EP (Etoposide - Cisplatin) chemotherapy. The initial stage was stage IIIB (T1 N2 M1a S2). After completion of chemotherapy he had no residual disease on CT scans of chest and abdomen and his tumour markers were normal. But on followup CT scan done in September 2010, he had developed a retroperitoneal mass with normal serum markers. He was followed up in the same hospital with serial CT scans and tumour markers till June 2012. The tumour markers were constantly normal and the mass was growing slowly. With these findings he presented to our department in June 2012. He was evaluated for metastatic disease and underwent laparatomy and excision of the mass. The post-operative histopathology was consistent with mature teratoma. Conclusion - Growing teratoma syndrome occurs in 1.9-7.6 percent of patients with metastatic nonseminomatous germ cell tumours. Vigilant and frequent imaging helps in its early diagnosis. Prompt and complete surgical resection are essential in giving the best chance for cure, preventing local complications and development of second malignancies