Growing teratoma syndrome with extra pelvic metastasis and gliomatosis peritonei

Abstract

•Growing teratoma syndrome occurs when mature teratomas are discovered in patients who have previously received adjuvant chemotherapy for immature teratoma.•Gliomatosis peritonei is a rare condition often found alongside immature teratoma.•Synchronous identification of growing teratoma syndrome and gliomatosis peritonei has rarely been reported.•Comprehensive abdominopelvic imaging is critical to the surveillance protocol after treatment of immature teratoma to assess and appropriately treat this phenomenon.

Keywords: Case report; Gliomatosis peritonei; Growing teratoma syndrome; Immature teratoma.

Fig. 1A-C

26-year-old female with lower abdominal pain, found to have small bilateral mature teratomas measuring approximately 4 cm, and large 18 cm left adnexal mass that is predominantly cystic and solid, with small scattered fatty components and tiny scattered calcification concerning for immature teratoma.

Fig. 1A-C

26-year-old female with lower abdominal pain, found to have small bilateral mature teratomas measuring approximately 4 cm, and large 18 cm left adnexal mass that is predominantly cystic and solid, with small scattered fatty components and tiny scattered calcification concerning for immature teratoma.

Fig. 1A-C

26-year-old female with lower abdominal pain, found to have small bilateral mature teratomas measuring approximately 4 cm, and large 18 cm left adnexal mass that is predominantly cystic and solid, with small scattered fatty components and tiny scattered calcification concerning for immature teratoma.

Fig. 2A-B

Ten months after surgical resection of immature teratoma, and seven months after chemotherapy completion the restaging CT demonstrates a 5 cm mass (red arrow), predominantly fatty with single calcification, with similar appearance to mature teratoma demonstrated in the CT performed at presentation. There is also trace peritoneal stranding (white circle), which is difficult to distinguish from benign process such as non-specific scarring, trace fluid, early/subtle malignant involvement of peritoneum, or gliomatosis peritonei. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2A-B

Ten months after surgical resection of immature teratoma, and seven months after chemotherapy completion the restaging CT demonstrates a 5 cm mass (red arrow), predominantly fatty with single calcification, with similar appearance to mature teratoma demonstrated in the CT performed at presentation. There is also trace peritoneal stranding (white circle), which is difficult to distinguish from benign process such as non-specific scarring, trace fluid, early/subtle malignant involvement of peritoneum, or gliomatosis peritonei. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2C

26-year-old female with lower abdominal pain, on ultrasound had bilateral mature teratomas measuring approximately 4 cm. Transvaginal ultrasound demonstrates hyperechoic mass (red arrow) with posterior attenuation (white *), known as the tip of the iceberg sign. Posterior and superior to the uterus fundus, solid mass with cystic component is partially visualized, demonstrating large pelvic mass with mixed solid and cystic component with minimal scattered fat better identified on CT.