Management of growing teratoma syndrome: Aachen University experience.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 385-385
Author(s):  
David J. K. P. Pfister ◽  
Daniel Porres ◽  
Andrea K. Thissen ◽  
Charlotte Piper ◽  
Axel Heidenreich
Keyword(s):  
Tumor Markers ◽  
Surgical Resection ◽  
Systemic Chemotherapy ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Vena Cava ◽  
Retroperitoneal Lymph Node Dissection ◽  
Tumor Diameter ◽  
Growing Teratoma Syndrome ◽  
Complete Surgical Resection

385 Background: Growing teratoma syndrome (GTS) is an infrequent clinical phenomenon. GTS is defined as an enlarging metastatic mass during systemic chemotherapy for advanced nonseminomatous germ cell tumors (NSGCT) despite decreasing serum tumor markers. Complete surgical resection of the mass is mandatory to achieve a favourable outcome. We report on our single center experience in the management of GTS. Methods: Between January 2000 and August 2009 postchemotherapeutic retroperitoneal lymph node dissection (PCRPLND) was performed in 162 patients (pts) with advanced NSGCT. Fourteen pts (4.9%) fulfilled the criteria of a GTS: enlarging metastatic mass in the retroperitoneum or visceral organs during systemic chemotherapy with normalized or regredient tumor markers. In all cases of GTS a complete radical bilateral PCRPLND including the resection of adjacent visceral and vascular structures was performed. Results: Median patient age was 24.5 (18 to 52) years. All patients exhibited NSGCT with a good or intermediate prognosis according to IGCCCG; in all cases the primary tumor contained predominantly (greater than 50%) mature teratoma; 10 and 4 patients presented with clinical stage IIC and III, resp. Median tumor diameter at time of surgery was 6,5 (3,0-35)cm. Tumor markers were normalized in 12 out of 14 patients and markers plateauted in 2 out of 14 patients. Tumor masses were localized in the retroperitoneum in 12 pts.; two patients had additional pulmonary metastases which were resected in a second approach. Median time from start of chemotherapy to surgery was 4.8 (1.5 to 26.5) months Median surgical time was 265 (165 to 585) minutes, and median blood loss 650 (450 to 2,000) ml. Four pts required resection of the inferior vena cava or abdominal aorta with implantation of a prosthetic graft; adjunctive nephrectomy was performed in three pts. After a median follow-up of 4.2 years two pts developed recurrent disease; the remainder are alive without evidence of disease. Conclusions: GTS is a rare phenomenom among pts with advanced NSGCT and necessitates complete surgical resection of all masses with curative intention. Surgery should be considered at time of progression to facilitate complete removal of the mass. Due to the complex surgery, treatment should be performed at specialized centers.

scholarly journals Growing Teratoma Syndrome: Two case reports

2021 ◽  
Author(s):  
anju shrestha ◽  
Hari Dhakal ◽  
Sirish Pandey ◽  
Kapendra Amatya ◽  
Sudip Shrestha ◽  
...  
Keyword(s):  
Tumor Markers ◽  
Surgical Resection ◽  
Case Reports ◽  
Mature Teratoma ◽  
Immature Teratoma ◽  
Surgical Staging ◽  
Growing Teratoma Syndrome ◽  
Complete Surgical Resection

We present two cases of nine and twenty-seven years old girls with recurrence of immature teratoma after an incomplete surgical staging. In both cases, there were huge abdominopelvic masses despite decrease in tumor markers with chemotherapy. Complete surgical resection of these masses was done, and histopathology showed only mature teratoma.

Surgical management of testicular cancer patients with complex postchemotherapy residual masses: Aachen University experience.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 387-387
Author(s):  
Axel Heidenreich ◽  
Daniel Porres ◽  
Charlotte Piper ◽  
Andrea K. Thissen ◽  
David J. K. P. Pfister
Keyword(s):  
Inferior Vena Cava ◽  
Tumor Markers ◽  
Abdominal Aorta ◽  
Inferior Vena ◽  
Germ Cell Tumors ◽  
Vena Cava ◽  
Tumor Diameter ◽  
Retroperitoneal Lymphadenectomy ◽  
Residual Masses ◽  
Vascular Structures

387 Background: Post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLND) represents the treatment of choice in patients with residual masses following chemotherapy for advanced non-seminomatous testicular germ cell tumors (NSGCT). Involvement of the abdominal aorta, the inferior vena cava or the thoracic/lumbar spine are rare but need complete resection for curative intent. We report on our single center experience in the management of such complex cases. Methods: Between January 2009 and September 2014 post-chemotherapeutic retroperitoneal lymph node dissection (PCRPLND) was performed in 162 patients (pts) with advanced NSGCT. Fourteen pts (4.9%) fulfilled the criteria of a GTS: enlarging metastatic mass in the retroperitoneum or visceral organs during systemic chemotherapy with normalized or regredient tumor markers. In all cases of GTS a complete radical bilateral PCRPLND including the resection of adjacent visceral and vascular structures was performed. Results: Median patient age was 24.5 (18 to 52). All patients exhibited NSGCT with a good or intermediate prognosis according to IGCCCG; 10 and 4 patients presented with clinical stage IIC and III, resp. Median tumor diameter at time of surgery was 6.5 (3,0-35)cm. Tumor markers were normalized in 12 out of 14 patients and markers plateauted in 2 out of 14 patients. Tumor masses were localized in the retroperitoneum in 12 pts; two pts had additional pulmonary metastases which were resected in a second approach. Median time from start of chemotherapy to surgery was 4.8 (1.5 to 26.5) months Median surgical time was 265 (165 to 585) minutes, median blood loss 650 (450 to 2,000) ml. Four pts required resection of the inferior vena cava or abdominal aorta with implantation of a prosthetic graft; adjunctive nephrectomy was performed in three pts. After a median follow-up of 4.2 years two pts developed recurrent disease; the remainder are alive without evidence of disease. Conclusions: Involvement of vascular structures and/or bone is a rare phenomenom among pts with advanced NSGCT and necessitates complete surgical resection of all masses with curative intention. Due to the complex surgery, treatment should be performed at specialized centers.

Is postchemotherapy retroperitoneal surgery necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses?

1992 ◽  
Vol 10 (4) ◽  
pp. 569-573 ◽  
Author(s):  
S D Fosså ◽  
H Qvist ◽  
A E Stenwig ◽  
H H Lien ◽  
S Ous ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Tumor Markers ◽  
Primary Tumor ◽  
Residual Disease ◽  
Mature Teratoma ◽  
Residual Tumor ◽  
Retroperitoneal Lymph Node Dissection ◽  
Retroperitoneal Mass ◽  
Residual Masses ◽  
Minimal Residual

PURPOSE At least one third of the patients with metastatic testicular cancer are rendered tumor-free by cisplatin-based chemotherapy. One may question, therefore, the routine use of postchemotherapy retroperitoneal lymph node dissection (RLND), especially if the residual masses are less than 20 mm in diameter. To define the role of such surgery, we analyzed the postchemotherapy histology in testicular cancer patients with minimal residual disease. PATIENTS AND METHODS Seventy-eight patients with advanced nonseminomatous testicular cancer underwent RLND after three to four cycles of cisplatin- or carboplatin-based chemotherapy. In all patients, the largest diameter of the residual retroperitoneal mass was less than 20 mm. RESULTS Complete fibrosis/necrosis was found in 51 patients, mature teratoma in 22, and vital malignant germ cell tumor in five. In two of the latter five patients, alphafetoprotein (AFP) had increased immediately before RLND. In the 76 patients with normal pre-RLND tumor markers, the presence of undifferentiated malignant teratoma (MTU) in the primary tumor and normal prechemotherapy tumor markers were independent parameters predicting complete fibrosis/necrosis, which was demonstrated in all 15 patients with these two pretreatment parameters. CONCLUSIONS Postchemotherapy RLND can be omitted in patients with MTU in the primary tumor who have normal AFP/human chorionic gonadotropin (AFP/HCG) before chemotherapy and whose residual retroperitoneal mass is less than 20 mm in diameter. If the pre-RLND tumor markers are normal, RLND should be performed in all other patients with small residual masses, even in the presence of a normal computed tomography (CT) and particularly if regular follow-up of the patients is not guaranteed.

Vascular anomalies in patients undergoing retroperitoneal lymph node dissection.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 382-382
Author(s):  
Andrea K. Thissen ◽  
Daniel Porres ◽  
David J. K. P. Pfister ◽  
Charlotte Piper ◽  
Axel Heidenreich
Keyword(s):  
Lymph Node ◽  
Renal Vein ◽  
Left Renal Vein ◽  
Germ Cell Tumors ◽  
Vena Cava ◽  
Vascular Anomalies ◽  
Retroperitoneal Lymph Node Dissection ◽  
Testis Cancer ◽  
Renal Veins ◽  
Retroperitoneal Lymph Node

382 Background: Anomalies of the renal vessels usually are clinically silent and might depicted during CT scanning of the abdomen for staging purposes of urological malignancies. Awareness of these rare anomalies is crucial especially in patients undergoing staging for germ cell tumors in order to avoid overstaging and unnecessary therapy. We report on the incidence of renal vessel anomalies in an unselected group of patients undergoing retroperitoneal lymph node dissection (RPLND) for testis cancer. Methods: 245 patients with testicular germ cell tumors underwent primary or secondary RPLND following inductive chemotherapy. Prior to RPLND, all patients underwent abdominal staging by CT scans or by MRI in selected cases. CT scans were reviewed with regard to the detection of vascular anomalies of the vena cava inf., renal veins, renal arteries, and iliac vessels. CT findings were correlated with intraoperative findings. Results: Overall, vascular anomalies were encountered in 39 patients (15.9%): retroaortic left renal vein in 10 (4.1%), circumaortic left renal vein in two (0.8%), reduplication of the common iliac vein in one (0.4%), accessory renal arteries in 14 (5.7%), thrombosis of the inferior vena cava in 12 (4.9%) patients with IIC disease. Anomalies of the renal vein were detected in 10 out of 12 (83%), in two cases venous anomalies were falsely diagnosed as lymph node disease in stage I NSGCT. All arterial anomalies were identified preoperatively. CT scan identified caval thrombosis in only eight cases (68%), four cases were identified by an additional MRI of the abdomen. Conclusions: Vascular anomalies are frequently encountered in patients with RPLND for testis cancer and have to be acknowledged during surgery even with negative imaging studies. Retroaortic renal veins represent a potential pitfall of CT imaging resulting in unnecessary therapy; it should be considered in pts with CT suspicious lymph nodes caudal to the renal hilus. IVC thrombosis is associated with advanced disease and is best diagnosed by MRI of the abdomen.

Applying radiomics to predict pathology of post chemotherapy retroperitoneal nodal masses in germ cell tumors (GCT).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4559-4559 ◽  
Author(s):  
Jeremy Howard Lewin ◽  
Paul Dufort ◽  
Jaydeep Halankar ◽  
Martin O'Malley ◽  
Michael A.S. Jewett ◽  
...  
Keyword(s):  
Predictive Value ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Prediction Algorithm ◽  
Pathological Examination ◽  
Retroperitoneal Lymph Node Dissection ◽  
Support Vector ◽  
Clinical Predictors ◽  
Clinical Variables ◽  
Platinum Chemotherapy

4559 Background: After chemotherapy, > 50% of patients (pts) with metastatic testicular GCT who undergo retroperitoneal lymph node dissection (RPNLD) for residual masses are found to have fibrosis (F) alone on pathological examination. To minimize overtreatment, better prediction algorithms are needed to identify pts with F who can avoid RPLND. Radiomics uses image processing techniques to extract quantitative textures/features from tumor regions of interest (ROI) to train a classifier that predicts pathological findings. We hypothesized that radiomics may identify pts with a high predicted likelihood of F who may avoid RPLND. Methods: Pts with GCT who had an RPLND for nodal masses > 1cm after first line platinum chemotherapy were included. Preoperative contrast enhanced axial CT images of retroperitoneal ROI were manually contoured. 153 radiomics features trained a radial basis function support vector machine classifier to discriminate between viable GCT /Mature Teratoma (T) vs F. Nested ten-fold cross-validation protocol was employed to determine classifier accuracy. Clinical variables and restricted size criteria were used to optimize the classifier. Results: A total of 82 pts with 102 ROI were analyzed (GCT: 21; T: 41; F: 40). The discriminative accuracy of radiomics to identify GCT/T vs F was 72%(±2.2)(AUC: 0.74 (±0.028); positive predictive value: 67% (48-92%); negative predictive value: 74% (62-84%)(p = 0.001)). No major predictive differences were identified when data was restricted by varying maximal axial diameters (AUC range: 0.58(±0.05) - 0.74(±0.03)). Prediction algorithm using clinical variables alone identified an AUC of 0.71 (±0.15). When these variables were added to the radiomic signature, the best performing classifier was identified when axial tumors were limited to diameter < 2cm (accuracy: 88.2 (±4.4); AUC: 0.80 (±0.05)(p = 0.02)). Conclusions: A predictive radiomics algorithm had an overall discriminative accuracy of 72% that improved to 88% when combined with clinical details. Further independent validation is required to assess whether radiomics, in conjunction with standard clinical predictors, may allow pts with a high predicted likelihood of F to avoid RPLND.

Clinical outcome of postchemotherapy salvage surgery for metastatic germ cell tumors in Japan

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14654-14654
Author(s):  
K. Kakimoto ◽  
T. Kinouchi ◽  
Y. Ono ◽  
N. Meguro ◽  
O. Maeda ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Germ Cell ◽  
Salvage Surgery ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Salvage Chemotherapy ◽  
Retroperitoneal Lymph Node Dissection ◽  
First Line ◽  
Residual Cancer ◽  
Line Chemotherapy

14654 Background: Salvage surgery including retroperitoneal lymph node dissection (RPLND) following chemotherapy has been considered a critical component in the comprehensive management of advanced germ cell tumors (GCT). The objectives of this study were to determine the pathologic findings and clinical outcome of patients with metastatic GCT who underwent postchemotherapy salvage surgery. Methods: From 1980 to 2004, 157 patients with metastatic diseases underwent postchemotherapy salvage surgery at three institutions. Surgical resection was indicated in the presence of residual radiographic abnormalities. The cause-specific survival rate was calculated using the Kaplan-Meier method. Results: The histology of GCT was pure seminoma in 49 patients and non-seminoma in 108 patients. As first-line chemotherapy, 30 patients were treated with PVB (cisplatin, vinblastine and bleomycin) regimen, 107 patients with PEB (cisplatin, etoposide and bleomycin) regimen and 20 patients with other regimens. Salvage surgery was performed after first-line chemotherapy in 87 patients and after salvage chemotherapy in 70 patients. As salvage surgery, RPLND was performed in 135 patients, resection of pulmonary metastasis in 38, hepatotomy in 2 and resection of metastatic brain tumors in 3. The pathological findings at surgery were necrosis in 87 (55%) patients, mature teratoma in 34 (22%) and residual cancer in 36 (23%). Five of 36 patients with residual cancer performed salvage surgery in the state of marker positive. Of the 31 patients who had residual cancer with normalized marker, salvage surgery was performed after salvage chemotherapy in 11 patients. The sites of residual cancer were retroperitoneal lymph nodes in 34 patients, lung in 4, brain in 2 and liver in 1. The cause-specific 5-year survival rates for patients who had necrosis, mature teratoma and residual cancer were 95%, 96% and 68%, respectively. Conclusions: Residual cancer could not reliably be predicted or discriminated from necrosis or mature teratoma. Therefore, salvage surgery to remove postchemotherapy residual masses remains essential in the successful treatment of metastatic GCT. No significant financial relationships to disclose.

Prognostic clinical parameters to predict the necessity of reconstructive vascular surgery for patients who undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for advanced nonseminatous germ cell tumors (NSGCT).

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 229-229
Author(s):  
A. Heidenreich ◽  
M. Schrader ◽  
K. Dieckmann ◽  
C. Winter ◽  
D. A. Pfister ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Vascular Surgery ◽  
Abdominal Aorta ◽  
Poor Prognosis ◽  
Inferior Vena ◽  
Mature Teratoma ◽  
Vena Cava ◽  
Complete Resection ◽  
Tumor Diameter ◽  
Residual Masses

229 Background: PC-RPLND remains an integral part of the multimodality treatment for advanced NSGCT. The need to resect and to replace the major retroperitoneal vessels must be known preoperatively to enable complete resection of the residual masses. Methods: PC-RPLND was performed in 411 patients with NSGCT and normalized (81%) or plateauing (19%) tumor markers following 3-4 cycles PEB/PEI. PC-RPLND was performed in 5 institutions with a variable surgical frequency of 14 to 158 PC-RPLNDs. Good, intermediate, and poor prognosis according to the IGCCCG criteria was identified in in 59.8%, 21.2%, and 19% respectively. Results: Resection of the inferior vena cava was performed in 28 (6.81%), resection of the abdominal aorta was necessary in 13 (3.16%) patients. In 29/41 (70.7%) adjunctive surgical procedures such as nephrectomy, small bowel resection, ureteral resection had to be performed to ensure complete resection of the residual masses. Histologically vital cancer or mature teratoma was identified in 78.1% of the resected vascular specimens. Mean time of surgery was 295 (243-615) Min., mean blood loss was 690 (350 – 3400) ml. Good prognosis was identified in 15.4%, intermediate and poor prognosis was present in 41%and 43.6%, resp. Of all 411 patients involvement of the major retroperitoneal vessels was found in 3.2%, 18.4% and 21.8% with good, intermediate, and poor prognosis, resp. The mean tumor diameter was 5.9 (1.0 – 32) cm for the entire cohort and 9.8 (4-32) cm for the cohort of patients with vascular surgery. Significant prognosticators to predict vascular involvement were identified by multivariate analysis: intermediate/poor prognosis, number of cycles of chemotherapy, tumor diameter > 14cm, circumferential encasement of > 50% of the vessel diameter. Conclusions: Complete resection of the inferior vena cava or the abdominal aorta during PC-RPLND is necessary in about 10% of patients. The identified predictors enable already preoperatively a risk adapted interdisciplinary approach for complete resection of the residual masses in an experienced centre. No significant financial relationships to disclose.

Intracranial growing teratoma syndrome mimicking tumor relapse: a diagnostic dilemma

2009 ◽  
Vol 3 (5) ◽  
pp. 392-396 ◽  
Author(s):  
Doo-Sik Kong ◽  
Do-Hyun Nam ◽  
Jung-Il Lee ◽  
Kwan Park ◽  
Jong Hyun Kim ◽  
...  
Keyword(s):  
Tumor Recurrence ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Clinical Manifestations ◽  
Serum Marker ◽  
Study Cohort ◽  
Diagnostic Dilemma ◽  
Primary Tumors ◽  
Growing Teratoma Syndrome ◽  
Second Look

Object It is important to differentiate growing teratoma syndrome (GTS) from tumor recurrence in the setting of an enlarging residual mass present after treatment of intracranial germ cell tumors (GCTs). The aim of this study was to determine the incidence of intracranial GTS and present its clinical manifestations in detail. Methods The authors performed a retrospective cohort study of 52 consecutive patients with newly diagnosed intracranial GCTs who presented between January 2000 and December 2006. The records were screened to identify a study cohort in which all patients had regrowing tumor mass despite normalization of tumor markers during or after treatment of GCTs. Results In 6 (11.5%) of 52 patients the pathological diagnosis was GTS. The median patient age at diagnosis was 14.5 years (range 2 months–17 years), and the primary tumors included 4 mixed GCTs and 2 immature teratomas. After second-look surgery, histological testing revealed the lesions to be mature teratoma in all patients. Three of 6 patients subsequently underwent radiation therapy and 1 patient received additional chemotherapy for spinal seeding. Conclusions In enlarging residual masses after treatment of intracranial GCTs, GTS should be kept in mind in the differential diagnosis of tumor recurrence especially if there is a radiographic mismatch with serum marker test results. If technically feasible, second-look surgery may be necessary for an accurate diagnosis.

scholarly journals Growing Teratoma Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Anna Scavuzzo ◽  
Zael Arturo Santana Ríos ◽  
Nancy Reynoso Noverón ◽  
Miguel Angel Jimenez Ríos
Keyword(s):  
Germ Cell ◽  
Surgical Resection ◽  
Surgical Management ◽  
Systemic Chemotherapy ◽  
Intraoperative Complications ◽  
Tumour Markers ◽  
Clinical Entity ◽  
Optimal Management ◽  
Rare Clinical Entity ◽  
Growing Teratoma Syndrome

Growing teratoma syndrome (GTS) is a rare clinical entity, which presents with enlarging teratomas masses of the retroperitoneum or other locations, occurring during or after systemic chemotherapy for the treatment of nonseminomatous germ cell of the testis (NSGCT), with normalised tumour markers. Awareness of this syndrome is necessary in order to prevent unnecessary chemotherapy and allow optimal management. Prognosis is excellent after the excision of these tumors, but surgery has to be as complete as possible. Surgical resection of bulky GTS lesions is technically challenging; intraoperative complications may occur; that is, why the treatment must not be delayed. Our experience in the surgical management of these lesions is reviewed in the following work.

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