Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 16, 2022; 10(14): 4704-4708
Published online May 16, 2022. doi: 10.12998/wjcc.v10.i14.4704
Ovarian growing teratoma syndrome with multiple metastases in the abdominal cavity and liver: A case report
Xu Hu, Zhong Jia, Li-Xin Zhou, Nisile Kakongoma
Xu Hu, The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310011, Zhejiang Province, China
Zhong Jia, Li-Xin Zhou, Department of Hepatobiliary Surgery, The First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Nisile Kakongoma, Hangzhou Women’s Hospital, Zhejiang Chinese Medical University, Hangzhou 310008, Zhejiang Province, China
Author contributions: Jia Z and Hu X analyzed the case and drafted the manuscript; Hu X also helped prepare the images; Zhou LX took part in the operation and perioperative management of the patient; Kakongoma N helped modify the language; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist-2016.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhong Jia, Doctor, Department of Hepatobiliary Surgery, The First People's Hospital, Zhejiang University School of Medicine, No. 261 Huang Sha, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. jiazhong664181@163.com
Received: December 24, 2021
Peer-review started: December 24, 2021
First decision: January 25, 2022
Revised: February 6, 2022
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: May 16, 2022
Processing time: 139 Days and 19.1 Hours
Abstract
BACKGROUND

Growing teratoma syndrome (GTS) is an unusual presentation of an amazing transformation of teratoma from malignant to benign on pathology during or after systemic or intraperitoneal chemotherapy. The definitive pathogenesis is still not fully understood due to the lack of large-sample studies.

CASE SUMMARY

A 53-year-old woman underwent radical surgery and postoperative intraperitoneal chemotherapy due to immature teratoma of the right ovary at the age of 28. She remained well during a 25-year follow-up period after surgery. Multiple asymptomatic solid masses were found in the liver on ultrasonography a month ago. Enhanced computed tomography (CT) of the abdomen revealed multiple masses in the abdominal cavity. The largest one was located in the posterior peritoneum next to the sixth segment of the right liver, about 7.9 cm × 7.5 cm in size. Three masses were present inside the liver, and one mass was in the right pelvic floor. Multiple lumps in the abdominal cavity were completely removed by surgery. During the operation, multiple space-occupying lesions were seen, ranging in size from 0.5 to 3 cm, and grayish white in color and hard in texture. Ovarian GTS was finally diagnosed based on postoperative pathology. After surgery, she recovered uneventfully. During a 3-year follow-up, the patient remained free of the disease without any recurrence on CT scan.

CONCLUSION

GTS is a rare phenomenon characterized by conversion of immature teratoma to mature one during or after chemotherapy and presents as growing and metastasizing masses. The pathogenesis of GTS is unclear, and the prognosis is good after surgical resection.

Keywords: Hepatic mass; Hypothesis of tumoral competitive inhibition and dormancy; Ovarian growing teratoma syndrome; Treatment; Case report

Core Tip: Growing teratoma syndrome (GTS) is a rare complication characterized by normal tumor markers during or after chemotherapy, but the size or number of tumor increases or both increases. At present, the mechanism has not yet been explained. In this regard, we propose a new hypothesis of tumor competitive inhibition and dormancy. It is recommended that clinicians should know the characteristics of the course of the disease, closely follow up the patients, diagnose and treat the disease timely, and avoid unnecessary chemotherapy. Surgical resection is the key to ensure a good prognosis of ovarian GTS.