Advertisement

Journal of Neuro-Oncology

, Volume 101, Issue 1, pp 109–115 | Cite as

Intracranial growing teratoma syndrome: clinical characteristics and treatment strategy

  • Chae-Yong Kim
  • Jung-Won Choi
  • Ji Yeon Lee
  • Seung-Ki Kim
  • Kyu-Chang Wang
  • Sung-Hye Park
  • Gheeyoung Choe
  • Hyo Seop Ahn
  • Il-Han Kim
  • Byung-Kyu ChoEmail author
Clinical Study – Patient Study

Abstract

This study evaluated the clinical and radiological characteristics, as well as the treatment outcomes, for the rare phenomenon known as intracranial growing teratoma syndrome (iGTS). One hundred seventy patients diagnosed with intracranial germ cell tumours (GCT) between 1997 and 2008 were enrolled in this retrospective analysis. Thorough reviews of medical records, brain magnetic resonance images (MRI), pathological findings and tumour markers [alpha-fetoprotein (αFP) and beta-human chorionic gonadotropin (βHCG)] were performed to identify the incidence of iGTS cases and to clarify their clinical characteristics. Eleven out of the 170 intracranial GCT patients (6.5%) were identified as having iGTS. All instances of iGTS originated from non-germinomatous GCT (NGGCT), with incidence rate of 21% (11/52). Six iGTS cases developed from mixed GCTs, four from immature teratomas (ITs) and one from yolk sac tumour. All 11 iGTS patients showed honeycomb-shaped multi-cystic growth patterns on MRI, which is a typical characteristic of iGTS. Surgical excision was performed in all patients, and complete excision was possible in nine patients. Eight of them are alive with no evidence of recurrence; however, two patients who had residual masses died owing to progression of iGTS. Early recognition and suspicion of iGTS, during or after adjuvant therapy of NGGCT, is crucial to ensure that surgical intervention can be performed in a timely manner. Early radical excision may be the treatment of choice for better iGTS prognosis.

Keywords

Intracranial germ cell tumour Diagnosis Treatment Growing teratoma syndrome Chemotherapy 

Notes

Acknowledgments

This study was supported by a grant from the National R&D Program for Cancer Control, Ministry of Health, Welfare and Family Affairs, Republic of Korea (No.0520300).

Financial Disclosure

The authors report no conflicts of interest

References

  1. 1.
    Cho KT, Wang KC, Kim SK, Shin SH, Chi JG, Cho BK (2002) Pediatric brain tumors: statistics of SNUH, Korea (1959–2000). Childs Nerv Syst 18:30–37CrossRefPubMedGoogle Scholar
  2. 2.
    Dearnaley DP, A’Hern RP, Whittaker S, Bloom HJ (1990) Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962–1987. Int J Radiat Oncol Biol Phys 18:773–781CrossRefPubMedGoogle Scholar
  3. 3.
    Matsutani M, Sano K, Takakura K et al (1997) Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86:446–455CrossRefPubMedGoogle Scholar
  4. 4.
    Logothetis CJ, Samuels ML, Trindade A, Johnson DE (1982) The growing teratoma syndrome. Cancer 50:1629–1635CrossRefPubMedGoogle Scholar
  5. 5.
    Jeffery GM, Theaker JM, Lee AH, Blaquiere RM, Smart CJ, Mead GM (1991) The growing teratoma syndrome. Br J Urol 67:195–202CrossRefPubMedGoogle Scholar
  6. 6.
    Tongaonkar HB, Deshmane VH, Dalal AV, Kulkarni JN, Kamat MR (1994) Growing teratoma syndrome. J Surg Oncol 55:56–60CrossRefPubMedGoogle Scholar
  7. 7.
    Andre F, Fizazi K, Culine S et al (2000) The growing teratoma syndrome: results of therapy and long-term follow-up of 33 patients. Eur J Cancer 36:1389–1394CrossRefPubMedGoogle Scholar
  8. 8.
    Itani Y, Kawa M, Toyoda S, Yamagami K, Hiraoka K (2002) Growing teratoma syndrome after chemotherapy for a mixed germ cell tumor of the ovary. J Obstet Gynaecol Res 28:166–171CrossRefPubMedGoogle Scholar
  9. 9.
    Rustin GJ, Newlands ES, Bagshawe KD, Begent RH, Crawford SM (1986) Successful management of metastatic and primary germ cell tumors in the brain. Cancer 57:2108–2113CrossRefPubMedGoogle Scholar
  10. 10.
    Lee AC, Chan GC, Fung CF, Leung SY, Lau YL (1995) Paradoxical response of a pineal immature teratoma to combination chemotherapy. Med Pediatr Oncol 24:53–57CrossRefPubMedGoogle Scholar
  11. 11.
    O’Callaghan AM, Katapodis O, Ellison DW, Theaker JM, Mead GM (1997) The growing teratoma syndrome in a nongerminomatous germ cell tumor of the pineal gland: a case report and review. Cancer 80:942–947CrossRefPubMedGoogle Scholar
  12. 12.
    Hanna A, Edan C, Heresbach N, Ben Hassel M, Guegan Y (2000) Expanding mature pineal teratoma syndrome: case report. Neurochirurgie 46:568–572PubMedGoogle Scholar
  13. 13.
    Yagi K, Kageji T, Nagahiro S, Horiguchi H (2004) Growing teratoma syndrome in a patient with a non-germinomatous germ cell tumor in the neurohypophysis: case report. Neurol Med Chir (Tokyo) 44:33–37CrossRefGoogle Scholar
  14. 14.
    Bi WL, Bannykh SI, Baehring J (2005) The growing teratoma syndrome after subtotal resection of an intracranial nongerminomatous germ cell tumor in an adult: case report. Neurosurgery 56:188PubMedGoogle Scholar
  15. 15.
    Kong DS, Nam DH, Lee JI, Park K, Kim JH, Shin HJ (2009) Intracranial growing teratoma syndrome mimicking tumor relapse: a diagnostic dilemma. J Neurosurg Pediatr 3:392–396CrossRefPubMedGoogle Scholar
  16. 16.
    Phi JH, Park SH, Paek SH et al (2007) Expression of Sox2 in mature and immature teratomas of central nervous system. Mod Pathol 20:742–748CrossRefPubMedGoogle Scholar
  17. 17.
    Wang KC, Kim SK, Park SH, Kim IO, Phi JH, Cho BK (2009) Intracranial germ cell tumors. In: Tonn JC et al (eds) Oncology of CNS tumors. Springer, Berlin, pp 563–577 (in press)Google Scholar
  18. 18.
    Hong WK, Wittes RE, Hajdu ST, Cvitkovic E, Whitmore WF, Golbey RB (1977) The evolution of mature teratoma from malignant testicular tumors. Cancer 40:2987–2992CrossRefPubMedGoogle Scholar
  19. 19.
    Kellie SJ, Boyce H, Dunkel IJ et al (2004) Primary chemotherapy for intracranial nongerminomatous germ cell tumors: results of the second international CNS germ cell study group protocol. J Clin Oncol 22:846–853CrossRefPubMedGoogle Scholar
  20. 20.
    Phi JH, Kim SK, Park SH, Hong SH, Wang KC, Cho BK (2005) Immature teratomas of the central nervous system: is adjuvant therapy mandatory? J Neurosurg Pediatr 103:524–530CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Chae-Yong Kim
    • 1
  • Jung-Won Choi
    • 1
  • Ji Yeon Lee
    • 2
  • Seung-Ki Kim
    • 2
  • Kyu-Chang Wang
    • 2
  • Sung-Hye Park
    • 3
  • Gheeyoung Choe
    • 4
  • Hyo Seop Ahn
    • 5
  • Il-Han Kim
    • 6
  • Byung-Kyu Cho
    • 2
    • 7
    Email author
  1. 1.Department of Neurosurgery, Clinical Neuro-Science Center, Seoul National University Bundang HospitalSeoul National University College of MedicineSeoulSouth Korea
  2. 2.Division of Pediatric Neurosurgery, Seoul National University Children’s HospitalSeoul National University College of MedicineSeoulSouth Korea
  3. 3.Department of Pathology, Seoul National University HospitalSeoul National University College of MedicineSeoulSouth Korea
  4. 4.Department of Pathology, Seoul National University Bundang HospitalSeoul National University College of MedicineSeoulSouth Korea
  5. 5.Department of Pediatrics, Cancer Research Institute, Seoul National University Children’s HospitalSeoul National University College of MedicineSeoulSouth Korea
  6. 6.Department of Radiation Oncology, Seoul National University HospitalSeoul National University College of MedicineSeoulSouth Korea
  7. 7.Department of NeurosurgerySeoul National University College of MedicineSeoulSouth Korea

Personalised recommendations