British Journal of Urology (1998), 81, 648 CASE REPORT The growing teratoma syndrome: an unusual case K.M. FEBER, D.W. SODERDAHL andK.L. HANSBERRY Madigan Army Medical Center, Department of Urology, Tacoma, Washington, USA Case reports A 22-year-old white man underwent treatment with combination chemotherapy, including bleomycin, etopo- side and cisplatin, for persistently elevated AFP (35.9 ng/mL; normal <20 ng/mL) after radical orchi- dectomy for a mixed germ cell testicular carcinoma. Histopathological examination revealed mixed germ cell tumour consisting of seminoma with syncytiotrophob- lasts and mature and immature teratoma. The findings on CT were normal, with retroperitoneal nodes of <1 cm. One month after his third cycle of chemotherapy the patient returned with a 3 week history of abdominal pain and vomiting. His serum levels of bhCG, LDH and Fig. 2. Micrograph of the resected mass showing mature teratoma. AFP were normal. Enhanced abdominal CT detected a Haematoxylin and eosin. Low power. 5 cm heterogeneous retroperitoneal mass (Fig. 1); the mass was completely excised. Histopathological analysis component in the primary specimen; (ii) elevated serum showed mature teratoma, which was thoroughly levels of AFP, bhCG and/or LDH with radiological evi- sampled to exclude undiCerentiated elements (Fig. 2). dence of metastatic disease; (iii) normalization of biomar- kers after chemotherapy; (iv) enlargement of the metastatic mass despite normal tumour markers; and Comment (v) mature teratoma in the resected specimen [1,2]. The Logothetis et al. [1] first described and coined the term 46 cases described previously have involved a mass ‘growing teratoma syndrome’’ (GTS) in 1982. In pre- existing before chemotherapy which enlarged despite vious series this syndrome occurred in 1.9–7.6% of standard therapeutic regimens. We describe a unique patients with metastatic nonseminomatous germ cell case that involves a mature teratoma enlarging during tumours who underwent chemotherapy [2,3]. The clini- chemotherapy, despite normal pre-treatment radiological cal definition of GTS includes: (i) a history of a nonsemin- findings, thus adding to the definition of GTS. omatous testicular neoplasm with a teratomatous References 1 Logothetis CJ, Samuels ML, Trindade A et al. The growing teratoma syndrome. Cancer 1982; 50: 1629–35 2 Hong WK, Wittes RE, Hajdu ST et al. The evolution of mature teratoma from malignant testicular tumors. Cancer 1977; 40: 2987–92 3 JeCery GM, Theaker JM, Lee AHS et al. The growing teratoma syndrome. Br J Urol 1991; 67: 195–202 Authors K.M. Feber, MD, Resident. D.W. Soderdahl, MD, StaC Urologist, Eisenhower AMC. K.L. Hansberry, MD, StaC Urologist. Correspondence: Dr K.M. Feber, Department of Urology, Madigan Army Medical Center, Tacoma, WA 98431, USA. The opinions expressed in this article are that of the authors and do not necessarily reflect the oBcial views of the US Army Fig. 1. The follow-up CT scan after three courses of platinum- Department of Defense. based chemotherapy, showing a 5 cm peri-aortic mass. 648 © 1998 British Journal of Urology

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Page 1: The growing teratoma syndrome: an unusual case

British Journal of Urology (1998), 81, 648

CASE RE PORT

The growing teratoma syndrome: an unusual caseK.M. FEBER, D.W. SODERDAHL and K.L. HANSBERRYMadigan Army Medical Center, Department of Urology, Tacoma, Washington, USA

Case reports

A 22-year-old white man underwent treatment withcombination chemotherapy, including bleomycin, etopo-side and cisplatin, for persistently elevated AFP(35.9 ng/mL; normal <20 ng/mL) after radical orchi-dectomy for a mixed germ cell testicular carcinoma.Histopathological examination revealed mixed germ celltumour consisting of seminoma with syncytiotrophob-lasts and mature and immature teratoma. The findingson CT were normal, with retroperitoneal nodes of<1 cm. One month after his third cycle of chemotherapythe patient returned with a 3 week history of abdominalpain and vomiting. His serum levels of bhCG, LDH and

Fig. 2. Micrograph of the resected mass showing mature teratoma.AFP were normal. Enhanced abdominal CT detected a Haematoxylin and eosin. Low power.5 cm heterogeneous retroperitoneal mass (Fig. 1); themass was completely excised. Histopathological analysis component in the primary specimen; (ii) elevated serumshowed mature teratoma, which was thoroughly levels of AFP, bhCG and/or LDH with radiological evi-sampled to exclude undiCerentiated elements (Fig. 2). dence of metastatic disease; (iii) normalization of biomar-

kers after chemotherapy; (iv) enlargement of themetastatic mass despite normal tumour markers; andComment(v) mature teratoma in the resected specimen [1,2]. The

Logothetis et al. [1] first described and coined the term46 cases described previously have involved a mass

‘growing teratoma syndrome’’ (GTS) in 1982. In pre-existing before chemotherapy which enlarged despite

vious series this syndrome occurred in 1.9–7.6% ofstandard therapeutic regimens. We describe a unique

patients with metastatic nonseminomatous germ cellcase that involves a mature teratoma enlarging during

tumours who underwent chemotherapy [2,3]. The clini-chemotherapy, despite normal pre-treatment radiological

cal definition of GTS includes: (i) a history of a nonsemin-findings, thus adding to the definition of GTS.

omatous testicular neoplasm with a teratomatous

References

1 Logothetis CJ, Samuels ML, Trindade A et al. The growingteratoma syndrome. Cancer 1982; 50: 1629–35

2 Hong WK, Wittes RE, Hajdu ST et al. The evolution ofmature teratoma from malignant testicular tumors. Cancer1977; 40: 2987–92

3 JeCery GM, Theaker JM, Lee AHS et al. The growing teratomasyndrome. Br J Urol 1991; 67: 195–202

Authors

K.M. Feber, MD, Resident.D.W. Soderdahl, MD, StaC Urologist, Eisenhower AMC.K.L. Hansberry, MD, StaC Urologist.Correspondence: Dr K.M. Feber, Department of Urology,Madigan Army Medical Center, Tacoma, WA 98431, USA.The opinions expressed in this article are that of the authorsand do not necessarily reflect the oBcial views of the US ArmyFig. 1. The follow-up CT scan after three courses of platinum-Department of Defense.based chemotherapy, showing a 5 cm peri-aortic mass.