The unusual and potentially fatal growing teratoma syndrome

ABSTRACT

Objective: Growing teratoma syndrome consists of germ cell tumors that grow following chemotherapy despite complete eradication of the malignant cells and normalization of the tumor markers. They can metastasize to any site, particularly the retroperitoneum, mediastinum and cervical region. Here we report our experience with this rare syndrome and stress the need for early recognition and treatment to avoid the subsequent morbidity and mortality associated with it. Patients and Methods: We reviewed the hospital records of patients suffering from testicular tumors with retroperitoneal metastasis treated at our hospital between January 2002 and December 2006. We included those who underwent radical orchiectomy, followed by chemotherapy and retroperitoneal lymphadenectomy for persistence of post-treatment large tumor, but whose tumor markers had normalized. Results: In this period, fourteen patients underwent retroperitoneal lymphadenectomy for persistence of tumor masses and normalization of tumor markers. Of these, the result of the anatomo-pathological examination was teratoma in six cases. Two of these patients evolved poorly and died from the disease; one because we were unable to fully remove the lesion, with subsequent renal insufficiency from bilateral ureteral obstruction and colonic obstruction with sepsis and the other due to cachexia because of the impossibility of removing the cervical and thoracic masses. Conclusions: Patients suffering from growing teratoma syndrome need to be recognized and treated surgically as soon as possible to avoid the negative consequences of morbidity and death, as occurred in two of our patients.