Growing Teratoma Syndrome a Rare Clinical Entity: Two Decades Management Experience from the Regional Cancer Institute

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ORIGINAL ARTICLE

Growing Teratoma Syndrome a Rare Clinical Entity: Two Decades Management Experience from the Regional Cancer Institute Praveen S. Rathod 1 & Amarinder Singh 1 & R. M. Punyashree 1 & V. R. Pallavi 1 & A. Usha 2 & C. R. Vijay 3 & K. Shoba 1 & K. Rajshekar 1 Received: 8 April 2020 / Accepted: 15 September 2020 # Indian Association of Surgical Oncology 2020

Abstract To study the clinical, biochemical, radiological, pathological characteristics, surgical treatment details, and follow-up of growing teratoma syndrome (GTS) patients. This is a retrospective study of GTS treated in the Department of Gynaecological Oncology at a regional cancer institute from March 2000 to March 2020. A total of 303 cases of germ cell ovarian cancers were treated, and 8 (2.6%) of 303 cases recurred as GTS during this period. The patients presenting with recurrent GTS were studied for clinical, radiological, tumor markers, surgical management, histopathology, and post-operative follow-up details that were analyzed retrospectively. The Kaplan-Meier curve was used for the survival analysis. The 8 out of 303 cases of germ cell ovarian cancers recurred as GTS and the incidence rate is 2.6% during this period. In the six (75%) of eight cases, the histopathology report was immature teratoma ovaries. The five cases (62.5%) were in advanced stage. All the eight recurrent GTS cases received optimal surgical cytoreduction. The overall disease-free survival is 85.7% and one patient has recurrence after the surgery for GTS at 23rd month of follow-up visit. All the patients are alive till date. The GTS represents a rare clinical and pathological phenomenon. Nevertheless, GTS should be considered as one of the differential diagnosis in young patients having normal tumor markers with recurrent carcinomatosis following the primary treatment germ cell tumors of ovaries. The optimal cytoreduction of recurrent GTS leads to prolonged survival and possible cure in young patients. Keywords Growing teratoma syndrome . Germ cell tumors of ovary . Cytoreduction . Gynecological oncology

Introduction The growing teratoma syndrome (GTS) is a rare clinical condition consisting of benign tumor implants containing mature teratoma during or after the diagnosis and treatment of malignant germ cell tumors. The GTS is typically characterized by paradoxical findings of having normal serum tumor markers and enlarging metastatic lesions on the clinical examination and/or imaging studies during the adjuvant chemotherapy

* Praveen S. Rathod [email protected] 1

Department of Gynaecologic Oncology, Kidwai Memorial Institute of Oncology, No. 25, Bengaluru, India

2

Department of Pathology, Kidwai Memorial Institute of Oncology, Bengaluru, India

3

Department of Biostatistics, Kidwai Memorial Institute of Oncology, Bengaluru, India

and/or follow-up period [1]. The reported incidence ranges between 1.9 and 7.6% in non-seminomatous germ cell of the testis and up to 12% in ovarian germ cell tumors [2, 3]. It was described by the first time by Smithers in the