Surgical Endoscopy

, Volume 34, Issue 2, pp 1019–1023 | Cite as

Surgical management of growing teratoma syndrome: robotic-assisted thoracoscopic resection of mediastinal teratoma

  • Richard Zheng
  • Courtney L. Devin
  • Thomas O’Malley
  • Francesco Palazzo
  • Nathaniel R. EvansIIIEmail author
Dynamic Manuscript



Growing teratoma syndrome is a rare condition defined by the presence of enlarging metastatic lesions on serial imaging that arise after or during systemic chemotherapy for nonseminomatous germ cell tumors. Lesions commonly occur in the retroperitoneum, mediastinum, or lung and are notoriously unresponsive to conventional chemoradiotherapy.


In this study, we present a dynamic case of a 26-year-old male, who had undergone surgical resection and systemic bleomycin treatment for a metastatic nonseminomatous germ cell tumor, and later developed recurrent masses in his posterior mediastinum seen on surveillance imaging. Tumor markers remained normal. These lesions were resected via a right robot-assisted thoracoscopic approach with the da Vinci Xi®.


The operation was completed successfully with an unremarkable postoperative hospital course. The robotic-assisted right thoracoscopic approach allowed for a minimally invasive dissection with good visualization and minimal morbidity when compared to previous cases of surgically resected mediastinal teratomas. Final pathology demonstrated mature teratomatous elements within a setting of inflammation and necrosis.


Robot-assisted thoracoscopic management of metastatic mediastinal lesions in the setting of this rare condition is safe and feasible.


Growing teratoma syndrome Xi robot Germ cell tumor Metastatic disease 




Compliance with ethical standards


Drs. Evans, Palazzo, O’Malley, Devin, and Zheng have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 70468 kb)

Supplementary material 2 (MPG 110796 kb)

Supplementary material 3 (MPG 96628 kb)


  1. 1.
    Logothetis CJ, Samuels ML, Trindade A, Johnson DE (1982) The growing teratoma syndrome. Cancer 50:1629–1635CrossRefGoogle Scholar
  2. 2.
    Gorbatiy V, Spiess PE, Pisters LL (2009) The growing teratoma syndrome: current review of the literature. Indian J Urol 25:186–189. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    DiSaia PJ, Saltz A, Kagan AR, Morrow CP (1977) Chemotherapeutic retroconversion of immature teratoma of the ovary. Obstet Gynecol 49:346–350PubMedGoogle Scholar
  4. 4.
    Carr B, Gilchrist KW, Carbone PP (1981) The variable transformation in metastases from testicular germ cell tumors: the need for selective biopsy. J Urol 126:52–54CrossRefGoogle Scholar
  5. 5.
    Smithers DW (1969) Maturation in human tumours. Lancet 294:949–952. CrossRefGoogle Scholar
  6. 6.
    Tangjitgamol S, Manusirivithaya S, Leelahakorn S, Thawaramara T, Suekwatana P, Sheanakul C (2006) The growing teratoma syndrome: a case report and a review of the literature. Int J Gyn Cancer 16:384–390CrossRefGoogle Scholar
  7. 7.
    Spiess P, Kassouf W, Brown G, Kamat A, Liu P, Gomez J, Tu S, Tannir N, Pisters L (2007) Surgical management of growing teratoma syndrome. J Urol 177:1330–1334CrossRefGoogle Scholar
  8. 8.
    Maroto P, Tabernero JM, Villavicencio H, Mesía R, Marcuello E, Solé-Balcells FJ, Sola C, Mora J, Algaba F, Pérez C, León X, López JJ (1997) Growing teratoma syndrome: experience of a single institution. Eur Urol 32:305–309CrossRefGoogle Scholar
  9. 9.
    Hirai Y, Yoshimasu T, Oura S, Okamura Y (2011) Mediastinal germ cell tumor with acute myeloid leukemia and growing teratoma syndrome. Interact Cardiovasc Thorac Surg 12:96–97. CrossRefPubMedGoogle Scholar
  10. 10.
    Matsuoka S, Koyama T, Takeda T, Yamada K, Hyogotani A, Hamanaka K, Sekiguchi N, Koizumi T (2019) Development of angiosarcoma in a mediastinal non-seminomatous germ cell tumor that exhibited growing teratoma syndrome during chemotherapy. Thorac Cancer 10:111–115. CrossRefPubMedGoogle Scholar
  11. 11.
    Iwata H, Mori Y, Takagi H, Shirahashi K, Shinoda J, Shimokawa K, Hirose H (2004) Mediastinal growing teratoma syndrome after cisplatin-based chemotherapy and radiotherapy for intracranial germinoma. J Thorac Cardiovasc Surg 127:291–293. CrossRefPubMedGoogle Scholar
  12. 12.
    Aide N, Comoz F, Sevin E (2007) Enlarging residual mass after treatment of a nonseminomatous germ cell tumor: growing teratoma syndrome or cancer recurrence? J Clin Oncol 25:4494–4496. CrossRefPubMedGoogle Scholar
  13. 13.
    Yoshioka M, Mori T, Okuma T, Kitamura N, Ito N, Nishi K (2000) Mediastinal growing teratoma syndrome. Jpn J Thorac Cardiovasc Surg 48:66–68CrossRefGoogle Scholar
  14. 14.
    Chen LT, Chen CL, Hwang WS (1990) The growing teratoma syndrome. A case of primary mediastinal nonseminomatous germ cell tumor treated with chemotherapy and radiotherapy. Chest 98:231–233CrossRefGoogle Scholar
  15. 15.
    Afifi HY, Bosl GJ, Burt ME (1997) Mediastinal growing teratoma syndrome. Ann Thorac Surg 64:359–362. CrossRefPubMedGoogle Scholar
  16. 16.
    D’Aiuto M, Veronesi G, Peccatori FA, Pelosi G, Venturino M, Gasparri R, Presicci F, Galetta D, Spaggiari L (2005) Mediastinal-like growing teratoma syndrome. J Thorac Cardiovasc Surg 130:228–229. CrossRefPubMedGoogle Scholar
  17. 17.
    Agatsuma T, Koizumi T, Kubo K, Saito G, Kondo R, Yoshida K, Ito K, Endo M, Shimojo H (2011) Mediastinal growing teratoma syndrome successfully treated by multiple modality therapies. Intern Med 50:607–610CrossRefGoogle Scholar
  18. 18.
    Sachdeva AK, Penumadu P, Kohli P, Dubashi B, Munuswamy H (2019) Growing teratoma syndrome in primary mediastinal germ cell tumor: our experience. Asian Cardiovasc Thorac Ann 27:98–104. CrossRefPubMedGoogle Scholar
  19. 19.
    Kesler KA, Patel JB, Kruter LE, Birdas TJ, Rieger KM, Okereke IC, Einhorn LH (2012) The “growing teratoma syndrome” in primary mediastinal nonseminomatous germ cell tumors: criteria based on current practice. J Thorac Cardiovasc Surg 144:438–443. CrossRefPubMedGoogle Scholar
  20. 20.
    Motoyama S, Sato Y, Wakita A, Kawakita Y, Nagaki Y, Imai K et al (2019) Extensive lymph node dissection around the left laryngeal nerve achieved with robot-assisted thoracoscopic esophagectomy. Anticancer Res 39:1337–1342CrossRefGoogle Scholar
  21. 21.
    Naffouje S, Salloum R, Khalaf Z, Salti G (2019) Outcomes of open versus minimally invasive ivor-lewis esophagectomy for cancer: a propensity-score matched analysis of NSQIP database. Ann Surg Oncol 26:2001–2010CrossRefGoogle Scholar
  22. 22.
    Cerfolio RJ, Bryant AS, Minnich DJ (2012) Operative techniques in robotic thoracic surgery for inferior or posterior mediastinal pathology. J Thorac Cardiovasc Surg 143:1138–1143CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Division of Thoracic and Esophageal Surgery, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

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