The "growing teratoma syndrome" in primary mediastinal nonseminomatous germ cell tumors

Criteria based on current practice

Kenneth Kesler, Jay B. Patel, Laura E. Kruter, Thomas Birdas, Karen Rieger, Ikenna C. Okereke, Lawrence Einhorn

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: Criteria for the growing teratoma syndrome in patients with primary mediastinal nonseminomatous germ cell tumors have not been well established according to current practice. Methods: An institutional database identified 188 patients who underwent postchemotherapy surgery for primary mediastinal nonseminomatous germ cell tumors from 1981 to 2009. We reviewed the subset of patients who underwent urgent surgery for tumor growth resulting in cardiopulmonary deterioration secondary to mediastinal compression precluding safe completion of 4 cisplatin-based chemotherapy cycles with rapidly declining serum tumor markers. Results: Five men (2.6%) with an average age of 25.8 years were identified. All patients initially presented with a large symptomatic anterior mediastinal mass and elevated serum tumor markers. Patients received an average of 2.4 chemotherapy cycles of a scheduled 4 courses before cardiopulmonary deterioration. Pathology of the resected specimens demonstrated mature teratoma in all patients; however, it was admixed in 4 patients with foci of immaturity (n = 1), malignant transformation of teratoma to sarcoma (n = 2), and nonseminomatous germ cell tumor (n = 2). There was 1 operative death. Three of the 4 operative survivors subsequently completed a total of 4 cycles of chemotherapy after recovery. Two patients are alive and well after an average of 14 years. Two patients died of metastatic disease. Conclusions: The growing teratoma syndrome should be defined not only as a growing mediastinal mass but also with secondary cardiopulmonary deterioration precluding safe completion of planned chemotherapy in the presence of declining serum tumor markers. Prompt recognition of this syndrome, discontinuation of chemotherapy, and surgical intervention can result in cure.

Original languageEnglish
Pages (from-to)438-443
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume144
Issue number2
DOIs
StatePublished - Aug 2012

Fingerprint

Teratoma
Drug Therapy
Tumor Biomarkers
Biomarkers
Nonseminomatous germ cell tumor
Sarcoma
Cisplatin
Survivors
Databases
Pathology
Growth

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

@article{0738031b274941c7a2313255404e0cc8,
title = "The {"}growing teratoma syndrome{"} in primary mediastinal nonseminomatous germ cell tumors: Criteria based on current practice",
abstract = "Objective: Criteria for the growing teratoma syndrome in patients with primary mediastinal nonseminomatous germ cell tumors have not been well established according to current practice. Methods: An institutional database identified 188 patients who underwent postchemotherapy surgery for primary mediastinal nonseminomatous germ cell tumors from 1981 to 2009. We reviewed the subset of patients who underwent urgent surgery for tumor growth resulting in cardiopulmonary deterioration secondary to mediastinal compression precluding safe completion of 4 cisplatin-based chemotherapy cycles with rapidly declining serum tumor markers. Results: Five men (2.6{\%}) with an average age of 25.8 years were identified. All patients initially presented with a large symptomatic anterior mediastinal mass and elevated serum tumor markers. Patients received an average of 2.4 chemotherapy cycles of a scheduled 4 courses before cardiopulmonary deterioration. Pathology of the resected specimens demonstrated mature teratoma in all patients; however, it was admixed in 4 patients with foci of immaturity (n = 1), malignant transformation of teratoma to sarcoma (n = 2), and nonseminomatous germ cell tumor (n = 2). There was 1 operative death. Three of the 4 operative survivors subsequently completed a total of 4 cycles of chemotherapy after recovery. Two patients are alive and well after an average of 14 years. Two patients died of metastatic disease. Conclusions: The growing teratoma syndrome should be defined not only as a growing mediastinal mass but also with secondary cardiopulmonary deterioration precluding safe completion of planned chemotherapy in the presence of declining serum tumor markers. Prompt recognition of this syndrome, discontinuation of chemotherapy, and surgical intervention can result in cure.",
author = "Kenneth Kesler and Patel, {Jay B.} and Kruter, {Laura E.} and Thomas Birdas and Karen Rieger and Okereke, {Ikenna C.} and Lawrence Einhorn",
year = "2012",
month = "8",
doi = "10.1016/j.jtcvs.2012.05.053",
language = "English",
volume = "144",
pages = "438--443",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - The "growing teratoma syndrome" in primary mediastinal nonseminomatous germ cell tumors

T2 - Criteria based on current practice

AU - Kesler, Kenneth

AU - Patel, Jay B.

AU - Kruter, Laura E.

AU - Birdas, Thomas

AU - Rieger, Karen

AU - Okereke, Ikenna C.

AU - Einhorn, Lawrence

PY - 2012/8

Y1 - 2012/8

N2 - Objective: Criteria for the growing teratoma syndrome in patients with primary mediastinal nonseminomatous germ cell tumors have not been well established according to current practice. Methods: An institutional database identified 188 patients who underwent postchemotherapy surgery for primary mediastinal nonseminomatous germ cell tumors from 1981 to 2009. We reviewed the subset of patients who underwent urgent surgery for tumor growth resulting in cardiopulmonary deterioration secondary to mediastinal compression precluding safe completion of 4 cisplatin-based chemotherapy cycles with rapidly declining serum tumor markers. Results: Five men (2.6%) with an average age of 25.8 years were identified. All patients initially presented with a large symptomatic anterior mediastinal mass and elevated serum tumor markers. Patients received an average of 2.4 chemotherapy cycles of a scheduled 4 courses before cardiopulmonary deterioration. Pathology of the resected specimens demonstrated mature teratoma in all patients; however, it was admixed in 4 patients with foci of immaturity (n = 1), malignant transformation of teratoma to sarcoma (n = 2), and nonseminomatous germ cell tumor (n = 2). There was 1 operative death. Three of the 4 operative survivors subsequently completed a total of 4 cycles of chemotherapy after recovery. Two patients are alive and well after an average of 14 years. Two patients died of metastatic disease. Conclusions: The growing teratoma syndrome should be defined not only as a growing mediastinal mass but also with secondary cardiopulmonary deterioration precluding safe completion of planned chemotherapy in the presence of declining serum tumor markers. Prompt recognition of this syndrome, discontinuation of chemotherapy, and surgical intervention can result in cure.

AB - Objective: Criteria for the growing teratoma syndrome in patients with primary mediastinal nonseminomatous germ cell tumors have not been well established according to current practice. Methods: An institutional database identified 188 patients who underwent postchemotherapy surgery for primary mediastinal nonseminomatous germ cell tumors from 1981 to 2009. We reviewed the subset of patients who underwent urgent surgery for tumor growth resulting in cardiopulmonary deterioration secondary to mediastinal compression precluding safe completion of 4 cisplatin-based chemotherapy cycles with rapidly declining serum tumor markers. Results: Five men (2.6%) with an average age of 25.8 years were identified. All patients initially presented with a large symptomatic anterior mediastinal mass and elevated serum tumor markers. Patients received an average of 2.4 chemotherapy cycles of a scheduled 4 courses before cardiopulmonary deterioration. Pathology of the resected specimens demonstrated mature teratoma in all patients; however, it was admixed in 4 patients with foci of immaturity (n = 1), malignant transformation of teratoma to sarcoma (n = 2), and nonseminomatous germ cell tumor (n = 2). There was 1 operative death. Three of the 4 operative survivors subsequently completed a total of 4 cycles of chemotherapy after recovery. Two patients are alive and well after an average of 14 years. Two patients died of metastatic disease. Conclusions: The growing teratoma syndrome should be defined not only as a growing mediastinal mass but also with secondary cardiopulmonary deterioration precluding safe completion of planned chemotherapy in the presence of declining serum tumor markers. Prompt recognition of this syndrome, discontinuation of chemotherapy, and surgical intervention can result in cure.

UR - http://www.scopus.com/inward/record.url?scp=84863988663&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863988663&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2012.05.053

DO - 10.1016/j.jtcvs.2012.05.053

M3 - Article

VL - 144

SP - 438

EP - 443

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 2

ER -