J Gynecol Oncol.  2010 Jun;21(2):129-131. 10.3802/jgo.2010.21.2.129.

Growing teratoma syndrome in a post laparoscopic excision of ovarian immature teratoma

• Sengar AR
• Kulkarni J

• KMID: 2009584
• DOI: http://doi.org/10.3802/jgo.2010.21.2.129

Abstract

A 26-year-old girl was referred to us in December 2008 with progressive pelvic mass while on chemotherapy. In May 2008, she presented with large adnexal mass and high alpha-fetoprotein (AFP, 265.7 ng/mL; normal range, 0 to 10). She underwent laparoscopic right salpingo-oophorectomy with staging. Since histology was immature teratoma grade I, FIGO stage 1 she was kept on surveillance. In September 2008, she developed recurrent pelvic mass with AFP levels of 2,400 ng/mL. Three courses of chemotherapy (bleomycin-etoposide-cisplatin) were given. Post-chemotherapy AFP normalized but tumor size increased. CT-scan (abdomen-pelvis) showed a large pelvic mass with calcification specks; infiltrating the sigmoid colon and abdominal wall. With provisional diagnosis of growing teratoma syndrome she had exploratory laparotomy with excision of pelvic mass along with sigmoid colon, excision of right pelvic and subcutaneous deposits, omentectomy and sigmoid anastomosis. Left ovary, left tube and uterus appeared normal and were preserved. Histology of all masses showed mature teratoma, no immature elements. At six months follow up she is disease free and has resumed menstruation. Growing teratoma syndrome is a clinico-pathological presentation during/post-chemotherapy in malignant ovarian germ cell tumor where mature teratoma grows and requires complete surgical excision. Our case highlights the safety and adequacy concerns of laparoscopic management of malignant ovarian tumor. Literature review suggests good prospects of resumption of menses, child bearing and five year survival in case of growing teratoma syndrome.

Keyword

Salpingo-oophorectomy; Growing teratoma syndrome; Immature teratoma; Malignant ovarian germ cell tumor; Chemotherapy; Laparoscopy

MeSH Terms

Abdominal Wall
Adult
alpha-Fetoproteins
Child
Colon, Sigmoid
Female
Follow-Up Studies
Humans
Laparoscopy
Laparotomy
Menstruation
Neoplasms, Germ Cell and Embryonal
Ovary
Reference Values
Teratoma
Ursidae
Uterus
alpha-Fetoproteins

Figure

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  Fig. 1 MRI abdomen pelvis showing complex right ovarian mass, marked by red dots.

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  Fig. 2 (A) PET-CT pelvis showing fluoro-2-deoxy-D-glucose (FDG) avid pelvic mass and abdominal wall deposit (marked by white arrow). (B) Photograph showing abdomino-pelvic mass marked in blue. Black arrow shows abdominal wall mass (port site of specimen extraction), other ports marked by black ellipse. (C) CT scan abdomen pelvis post chemotherapy showing increased calcification in pelvic mass. (D) Specimen showing pelvic mass (M), two ends of sigmoid colon (S), anterior abdominal wall deposit (A), and omentum (O).

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