Soňa Huľová, Ramadan Aziri, Michal Chovanec, Jozef Mardiak, Michal Mego, Daniel Pinďák


Background: Growing teratoma syndrome (GTS) is an uncommon clinical finding in patients treated for testicular cancer. It is diagnosed during or after chemotherapy as an expanding tumour mass not responding to the treatment while the serum tumour markers keep within the normal range. Pathological evaluation of resected tissue confirms the structures of benign mature teratoma.


Methods: Authors report a case of metastatic germ cell testicular cancer treated with two lines of chemotherapy and everolimus, that had finally been subjected for the resection of voluminous metastatic masses. We give a brief overview of current records concerning clinical management of growing teratoma syndrome, and support the major role of surgical treatment in GTS.


Results: Patient with metastatic mixed germ cell tumour of testis underwent the radical orchiectomy and completed the first-line treatment with BEP (bleomycin, etoposide, cisplatin) regimen. Radiographic restaging showed considerable disease progression to the retroperitoneum and supraclavicular lymph nodes. Second-line treatment with VIP (etoposide, ifosfamide, cisplatin) did not reverse the progression and the patient was consulted at our institute. Following the enrolment to the clinical study with everolimus, the patient exhibited continual metastatic growth in contrast to serum markers decrease. Growing teratoma syndrome was confirmed after resection of enormous retroperitoneal tumour mass, as well as from the specimen obtained from the subsequent supraclavicular and hepatal metastasectomy. The patient attained complete remission and has been closely observed 31 months by now since the last surgery.


Conclusions: GTS is resistant to chemotherapy and radiation and complete surgical resection results in excellent disease control. Clinicians should be aware of this infrequent presentation of testicular tumours, to ensure the  timely diagnosis and the appropriate surgical removal without any delay. Despite the great extent and vital vasculature encasement, surgery may be feasible and successful, as we report in our case, consistently with the published data.

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Key words: testicular neoplasms, teratoma, surgery, prognosis

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