IRIA 67th Annual Conference Chennai - 2014 GROWING TERATOMA SYNDROME - A RARE COMPLICATION OF IMMATURE TERATOMA OF OVARY Department of Radio-Diagnosis and Imaging SAVEETHA MEDICAL COLLEGE HOSPITAL Thandalam, Kancheepuram Dr. Janani A.V. (PG resident) Dr. Upasana Ranga M.D.(RD) (Associate Professor) Dr. A. Senthil Kumar M.D.(RD) (Associate Professor) Dr. Saveetha Veeraiyan M.D.(RD) (Professor) Saveetha Medical College Hospital

4/22/2017 CASE HISTORY An 18-year-old unmarried female presented with abdominal fullness of 3 months duration. The patient had undergone laparoscopic cystectomy for left ovarian cyst at another hospital 10 months back. The histopathology had revealed an immature teratoma of the left ovary. After two initial rounds of chemotherapy the patient had discontinued treatment. Tumor markers were not elevated presently. Saveetha Medical College Hospital

USG images of abdomen showing multiple heterogenous solid (white arrow) and cystic (black arrow) deposits in peritoneal cavity with calcification (curved white arrow) and fatty areas in most of them. Saveetha Medical College Hospital

AXIAL CECT ABDOMEN showing gross ascites with multiple enhancing soft tissue deposits with fat and calcification within peritoneal cavity, abutting posterior part of right lobe of liver. Saveetha Medical College Hospital

AXIAL CECT ABDOMEN showing gross ascites with multiple enhancing soft tissue deposits with fat (blue arrow) and calcification (yellow arrow) within peritoneal cavity, along with pelvic mass containing fat and calcification. Saveetha Medical College Hospital

SAGITTAL & CORONAL CECT images showing large pelvic mass with fat and calcification (yellow arrow) posterior to uterus along with ascites and multiple soft tissue deposits with fat (red arrow) and calcification suggestive of peritoneal dissemination. Saveetha Medical College Hospital

DIAGNOSIS Ultrasound and CT scan revealed gross ascites with multiple complex solid-cystic lesions in the peritoneal cavity with most of them showing fat and calcification . The uterus was normal but both the ovaries could not be visualized separately. Based on clinical and imaging findings, a diagnosis of Growing Teratoma Syndrome was made. Debulking surgery was performed and histo- pathology of resected deposits showed mature teratoma with no immature elements. Saveetha Medical College Hospital

CASE DISCUSSION Growing Teratoma syndrome (GTS) is a rare complication of malignant germ cell tumors (GCT) developing during the course or after completion of chemotherapeutic treatment. It refers to growth of benign teratomatous lesion in a case of malignant GCT in presence of normal serum tumor markers. Widely accepted theories include selective destruction of immature malignant cells during chemotherapy with proliferation of only mature elements and chemotherapy-induced differentiation of malignant cells into benign ones. Saveetha Medical College Hospital

CLINICAL PRESENTATION Commoner modes of spread are hematogenous and lymphatic. Time of occurrence after initial treatment varies. Malignant transformation into sarcoma, glioma, or carcinoids can occur. Serum tumor markers are not elevated,in contrast with residual / recurrent immature GCT which is associated with increased levels. Saveetha Medical College Hospital

TREATMENT Surgical debulking is performed to reduce tumor burden, its complications and possibility of malignant transformation. Chemotherapy and radiotherapy do not play significant roles. Since time duration is variable and disease burden increases with time, it is advisable to keep all patients with immature teratoma under follow up. Saveetha Medical College Hospital

SUMMARY Growing teratoma syndrome is a rare complication of malignant germ cell tumors of ovary developing during or after completion of chemotherapeutic treatment. It refers to growth of benign teratomatous lesion in a case of malignant GCT in presence of normal serum tumor markers. Surgical debulking is performed to reduce tumor burden, its complications and possibility of malignant transformation. It is always advisable to keep patients with immature teratoma under follow up, to detect growing teratoma syndrome in initial stages. Saveetha Medical College Hospital

REFERENCES Logothetis CJ, Samuels ML, Trindade A, Johnson DE. The growing teratoma syndrome. Cancer. 1982 Oct 15;50(8):1629- 35. Mrabti H, El Ghissassi I, Sbitti Y, Amrani M, Hachi H, Errihani H. Growing teratoma syndrome and peritoneal gliomatosis. Case Rep Med. 2011;2011:123527. Djordjevic B, Euscher ED, Malpica A. Growing Teratoma syndrome of the ovary: Review of literature and first report of a carcinoid tumor arising in a growing teratoma of the ovary. Am J Surg Pathol. 2007;31:1913-8. Lorusso D, Malaguti P, Trivellizzi IN, Scambia G. Unusual liver locations of growing teratoma syndrome in ovarian malignant germ cell tumors. Gynecol Oncol Case Rep. 2011 Aug 8;1(1):24-5. Saveetha Medical College Hospital