Abstract
Purpose
Thoracic growing teratoma syndrome (TGTS) is a rare disease in patients with germ cell tumors. Other than a few case reports and a limited number of case series, studies of this topic are not available.
Methods
We retrospectively analyzed the data from our patients who received surgery for TGTS between 1999 and 2016. Descriptive statistical analyses were performed to analyze the characteristics of the patients, tumors, and short-term outcomes. Furthermore, the long-term outcomes and survival curves were analyzed using the Kaplan–Meier method.
Results
Twenty-nine patients underwent surgery for TGTS. The median age was 32 years (range: 19–50 years). All patients received cisplatin-based chemotherapy. Many of the patients had multilocalized TGTS (n = 10). The median tumor size was 64.5 mm (range 10-210 mm). In all cases, R0 resection was achieved. The minor morbidity, major morbidity, and mortality rates were 3.4%, 6.9%, and 0%, respectively. Altogether, 28 patients were included in the long-term follow-up analysis, with a median follow-up time of 94 months (13–237 months). The 5-, 10-, and 15-year survival rates were 93%, 93%, and 84%, respectively.
Conclusions
TGTS may occur in multiple localizations and grow to a large tumor size. The resection of TGTS can be performed with low morbidity and mortality rates and is associated with good overall survival after complete resection. Important are an early detection and knowledge of the systemic treatment options by the oncologist and urologist, as well as a thoracic surgeon with a large experience in extended thoracic resections.
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References
Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, Horwich A, Laguna MP, Nicolai N, Oldenburg J (2015) European association of urology. Guidelines on testicular cancer update. Eur Urol 68(6):1054–1068. https://doi.org/10.1016/j.eururo.2015.07.044(Epub 2015 Aug 18)
Albert Thomas (2018) Cancer Today - Globocan 2018: Available from: https://gco.iarc.fr/today/data/factsheets/cancers/28-Testis-fact-sheet.pdf (Accessed on 10 Nov 2019).
Kesler KA (2002) Surgical techniques for testicular nonseminomatous germ cell tumors metastatic to the mediastinum. Chest Surg Clin N Am 12(4):749–768
Sponholz S, Trainer S, Schirren M, Schirren J (2019) Resection of retrocrural germ cell tumor metastases: two surgical approaches. J Thorac Cardiovasc Surg 157(6):2482–2489. https://doi.org/10.1016/j.jtcvs.2019.01.119(Epub 2019 Feb 13)
Einhorn LH (1990) Treatment of testicular cancer: a new and improved model. J Clin Oncol 8(11):1777–1781
Hinton S, Catalano PJ, Einhorn LH, Nichols CR, Crawford ED, Vogelzang N, Trump D, Loehrer PJ Sr (2003) Cisplatin, etoposide and either bleomycin or ifosfamide in the treatment of disseminated germ cell tumors: final analysis of an intergroup trial. Cancer 97(8):1869–1875
Kesler KA, Kruter LE, Perkins SM, Rieger KM, Sullivan KJ, Runyan ML, Brown JW, Einhorn LH (2011) Survival after resection for metastatic testicular nonseminomatous germ cell cancer to the lung or mediastinum. Ann Thorac Surg 91(4):1085–1093. https://doi.org/10.1016/j.athoracsur.2010.12.034
Schirren J, Trainer S, Eberlein M, Lorch A, Beyer J, Bölükbas S (2012) The role of residual tumor resection in the management of nonseminomatous germ cell cancer of testicular origin. Thorac Cardiovasc Surg 60(6):405–412
Logothetis CJ, Samuels ML, Trindade A, Johnson DE (1982) The growing teratoma syndrome. Cancer 50(8):1629–1635
Hiester A, Nettersheim D, Nini A, Lusch A, Albers P (2019) Management, treatment, and molecular background of the growing teratoma syndrome. Urol Clin North Am 46(3):419–427. https://doi.org/10.1016/j.ucl.2019.04.008(Epub 2019 May 29)
Paffenholz P, Pfister D, Matveev V, Heidenreich A (2018) Diagnosis and management of the growing teratoma syndrome: A single-center experience and review of the literature. Urol Oncol 36(12):529.e23-529.e30. https://doi.org/10.1016/j.urolonc.2018.09.012(Epub 2018 Nov 13)
Stella M, Gandini A, Meeus P, Aleksic I, Flechon A, Cropet C, Droz JP, Rivoire M (2012) Retroperitoneal vascular surgery for the treatment of giant growing teratoma syndrome. Urology 79(2):365–370. https://doi.org/10.1016/j.urology.2011.08.076(Epub 2011 Dec 14)
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(2):438–443. https://doi.org/10.1016/j.jtcvs.2012.05.053(Epub 2012 Jun 17)
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(2):98–104. https://doi.org/10.1177/0218492318823345(Epub 2019 Jan 15)
Afifi HY, Bosl GJ, Burt ME (1997) Mediastinal growing teratoma syndrome. Ann Thorac Surg 64(2):359–362
Maroto P, Tabernero JM, Villavicencio H, Mesía R, Marcuello E, Solé-Balcells FJ, Sola C, Mora J, Algaba F, Pérez C, León X, López López JJ (1997) Growing teratoma syndrome: experience of a single institution. Eur Urol 32(3):305–309
André F, Fizazi K, Culine S, Droz J, Taupin P, Lhommé C, Terrier-Lacombe M, Théodore C (2000) The growing teratoma syndrome: results of therapy and long-term follow-up of 33 patients. Eur J Cancer 36(11):1389–1394
Tanaka K, Toyokawa G, Tagawa T, Ijichi K, Haratake N, Hirai F, Oda Y, Maehara Y (2018) Successful treatment of growing teratoma syndrome of the lung by surgical resection: a case report and literature review. Anticancer Res 38(5):3115–3118
Kim D, Kim SW, Hong JM (2014) Rapid growing huge teratoma: complete surgical resection. J Thorac Dis 6(10):E217–E219. https://doi.org/10.3978/j.issn.2072-1439.2014.08.05
Seely AJ, Ivanovic J, Threader J, Al-Hussaini A, Al-Shehab D, Ramsay T, Gilbert S, Maziak DE, Shamji FM, Sundaresan RS (2010) Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 90(3):936–942. https://doi.org/10.1016/j.athoracsur.2010.05.014 ((discussion 942))
Carver BS, Bianco FJ, Shayegan B, Vickers A, Motzer RJ, Bosl GJ, Sheinfeld J (2006) Predicting teratoma in the retroperitoneum in men undergoing post-chemotherapy retroperitoneal lymph node dissection. J Urol 176:100–103. https://doi.org/10.1016/S0022-5347(06)00508-8 ((discussion 103-4))
Motzer RJ, Amsterdam A, Prieto V, Sheinfeld J, Murty VV, Mazumdar M, Bosl GJ, Chaganti RS, Reuter VE (1998) Teratoma with malignant transformation: diverse malignant histologies arising in men with germ cell tumors. J Urol 159(1):133–138
Acknowledgements
This study is part of the doctoral thesis of Kyriaki Chalepaki Ntelli. The authors have no financial relationships, conflicts of interest, informed consent or funding sources to declare.
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SS: Project development, Data management, Data analysis, Manuscript writing. CNK: Data management and analysis, Manuscript writing. KG: Data management, Manuscript writing. SM: Project development, Manuscript writing. LA: Data management, Manuscript writing. HA: Data management, Manuscript writing. AP: Data management, Manuscript writing. SJ: Project development, Data management, Manuscript writing.
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The Institutional Review Board approved the study (Landesärztekammer Hessen/2019-1437-evBO), which was conducted according to the revised Declaration of Helsinki and the requirements for good clinical practice.
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Sponholz, S., Chalepaki Ntelli, K., Karaindros, G. et al. Short-term and long-term outcomes after resection of thoracic growing teratoma syndrome. World J Urol 39, 2579–2585 (2021). https://doi.org/10.1007/s00345-020-03503-6
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DOI: https://doi.org/10.1007/s00345-020-03503-6