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The growing teratoma syndrome
S G Basheda1, G Gephardt, D P Meeker
1Department of Pulmonary Disease, Cleveland Clinic Foundation.
Abstract:
A 26-year-old man presented with multiple pulmonary nodules and a left testicular mass. Combination chemotherapy for a malignant, mixed germ cell testicular tumor resulted in shrinkage of the pulmonary nodules and normalization of the tumor markers (beta-HCG, LDH and AFP). Subsequent surgical excision performed for enlargement of the pulmonary nodules revealed mature teratomas, diagnostic of the GTS.
Insights
Chemotherapy effectively treated a mixed germ cell testicular tumor, shrinking pulmonary nodules and normalizing tumor markers. Surgical removal later confirmed mature teratomas, indicating a complete response to treatment.
Area of Science:
- Oncology
- Urology
- Pathology
Background:
- Germ cell tumors (GCTs) are the most common malignancy in young men.
- Mixed germ cell tumors (MGCTs) comprise various neoplastic elements, including teratoma.
- Pulmonary metastases are a common manifestation of advanced GCTs.
Observation:
- A 26-year-old male presented with a left testicular mass and multiple pulmonary nodules.
- Initial evaluation suggested a malignant, mixed germ cell testicular tumor.
Findings:
- Combination chemotherapy led to significant shrinkage of pulmonary nodules and normalization of tumor markers (beta-human chorionic gonadotropin, lactate dehydrogenase, and alpha-fetoprotein).
- Subsequent surgical excision of persistent pulmonary nodules revealed mature teratomas.
- The findings confirmed the diagnosis of extragonadal germ cell tumors (GCTs) with teratomatous transformation.
Implications:
- This case highlights the efficacy of chemotherapy in managing advanced GCTs with metastatic disease.
- Mature teratomas can represent post-chemotherapy residual disease in GCTs.
- Surgical resection remains crucial for definitive diagnosis and treatment of residual teratomatous components.