Managing Growing Teratoma Syndrome: New Insights and Clinical Applications

Figures & data

Table 1. Growing teratoma syndrome: review of literature with cases >10 cm in size.

Number of cases	Study (year)	Age	Initial histo	Size of immature teratoma (cm)	Stage	Grade	Surgery	Chemotherapy	Tumor markers after primary treatment	Re-presentation (months)	Site	Size (cm)	Final histo	Surgery	Outcome
1	Aronowitz (1983)	15	Immature teratoma left ovary	N/R	IA	3	LSO and wedge biopsy of right ovary and omentum	Vin, Act, Cyclo (11)	N/R	12	Multicystic pelvic mass adjacent to right ovary	12	Mature teratoma	RSO, total hysterectomy and removal of pelvic mass	Alive
2	Itani (2002)	24	Immature teratoma right ovary	16 × 9	IC	N/R	Right adnexectomy and enucleation of cystic tumor of left ovary	BEP (3)	Negative	15	Right para-aortic lesion occupying all right retroperitoneal cavity	11 × 6	Mature teratoma	Cytoreductive surgery	Alive
3	Tangjitgamol (2006)	5	Immature teratoma ovary N/R	11	IA	3	SO	BEP (2) VAC (2)	Negative	5	16 cm tumor mass beneath the right diaphragm and tumor nodules in cul-de-sac	16	Mature teratoma	Surgical resection and debulking	Alive
4	Dewdney (2006)	19	Immature teratoma right ovary	30	N/R	3	Exploratory laparotomy	BEP (3)	N/R	8	Mid-abdominal mass encasing retroperitoneal vessels with internal calcifications and severe left hydronephrosis	25	Mature teratoma	Laparotomy and resection of mass and left-sided percutaneous nephrostomy	Alive
5	Malik (2008)	22	Immature teratoma left ovary	20 × 25	IA	3	LSO	Vin, Act, Cyclo (3)	Negative	36	Pelvis + abdomen	20 × 20	Mature teratoma	Mass resection after adhesiolysis and infracolic omentectomy	Alive
6	Rashmi (2010)	19	Immature teratoma left ovary	25 × 20	IA	3	LSO and omental Bx	3 cycles of chemo, type N/R	N/R	36	Pelvis + abdomen	20 × 20	Mature teratoma	Excision of tumor, adhesiolysis, omentectomy and peritoneal Bx	Alive
7	Sengar (2010)	26	Mature and immature teratoma right ovary	N/R	IA	1	RSO, pelvic LND + omental Bx	BEP (3)	N/R	6	Pelvis + abdomen	17	Mature cystic teratoma	Excision of tumor from sigmoid colon, right pelvic nodule, AAW nodule and omentectomy	Alive
8	Mrabti (2011)	18	Immature teratoma right ovary	22 × 18	IC	2	TAH, RSO and omentectomy	Cis + Eto (6)	Negative	6	Pelvis + abdomen	25 × 21	Mature teratoma	Excision of tumor	Alive
9	Altinbas (2012)	52	Immature teratoma ovary N/R	N/R	3C	3	TAH, BSO, PA LND and omentectomy	BEP (6) Paclitaxel (3)	Negative	36	Liver, diaphragm, abdomen, pelvis, pelvic lymph nodes	20 × 10	Mature teratoma	Excision from liver, diaphragm, peritoneum, sigmoid colon, omentum and RP	Alive
10	Ohashi (2014)	30	Immature teratoma ovary N/R	N/R	3C	N/R	TAH + BSO	N/R	N/R	216	Pelvis + abdomen	40 × 40	Mature teratoma	Excision of tumor	Alive
11	Mir (2014)	16	Immature teratoma ovary N/R	N/R	N/R	N/R	TAH + BSO	BEP (3)	N/R	36	Abdomen	40 × 25	Mature teratoma	Excision of tumor + peritonectomy	Alive

AAW: Anterior abdominal wall; Act: Actinomycin D; BEP: Bleomycin, etoposide, cisplatin; BSO: Bilateral salpingo-oophorectomy; Bx: Biopsy; Cyclo: Cyclophosphamide; Eto: Etoposide; Histo: Histology; LND: Lymph node dissection; LSO: Left salpingo-oophorectomy; N/R: Not recorded; Omentect: Omentectomy; PA: Para-aortic; RP: Retroperitoneum; RSO: Right salpingo-oophorectomy; SO: Salpingo-oophorectomy; TAH: Total abdominal hysterectomy; VAC: Vinblas­tine, Adria­mycin, Cisplatin; Vin: Vincristine.

Figure 1. Algorithm of management of growing teratoma syndrome.

GCT: Granulosa cell tumor; GTS: Growing teratoma syndrome.