Late recurrence of mature teratoma in nonseminomatous testicular tumors after PVB chemotherapy and surgery

Abstract

We present the case histories of 3 patients in whom a growing mature teratoma developed twenty-eight, thirty-one, and thirty-three months after successful remission-induction chemotherapy with cisplatinum, vinblastine, and bleomycin (PVB) for a disseminated nonseminomatous testicular tumor (NSTT). The serum tumor markers were not increased. The teratomas were all localized retroperitoneally, two being found near the site of excision of a residual tumor after remission-induction chemotherapy. Two of the 3 patients were alive without further treatment after excision of the teratoma; the third patient did not die of tumor progression, but mature teratoma was still present. Even if the serum tumor markers are not increased, recurrent tumors in patients previously given PVB chemotherapy because of a disseminated NSTT should be excised to establish their histology. En-bloc excision of the recurrent tumor is sufficient. It is pointed out that a mature teratoma can become a large cystic tumor in the course of time: the so-called growing mature teratoma syndrome. We believe that, after remission-induction chemotherapy of disseminated NSTT with a teratoma component in the primary testicular tumor, any residual tumor should be excised to prevent subsequent tumor progression.