Shigeta Naoya, Kobayashi Eiji, Sawada Kenjiro, Ueda Yutaka, Yoshino Kiyoshi, Hori Yumiko, Kimura Tadashi
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
J Minim Invasive Gynecol. 2015 May-Jun;22(4):668-74. doi: 10.1016/j.jmig.2015.01.011. Epub 2015 Jan 22.
Growing teratoma syndrome (GTS) is rare clinical phenomenon occurring as a sequelae of a malignant germ cell tumor. We present the case of a 20-year-old woman who developed GTS after undergoing fertility-sparing surgery and chemotherapy for an immature teratoma. She underwent left salpingo-oophorectomy, right ovarian cystectomy, and disseminated tumor reduction during her primary surgery. The postsurgical histology report identified the tumor as an immature teratoma, grade 3, International Federation of Gynecology and Obstetrics (FIGO) stage IIIb. She subsequently received 3 cycles of chemotherapy consisting of bleomycin, etoposide, and cisplatin. At 17 months after the chemotherapy, follow-up computed tomography (CT) scan revealed an enlarged mass in her right paracolic gutter and a small peritoneal lesion in the pouch of Douglas. Her serum alpha-fetoprotein level was not elevated. These findings were compatible with GTS, but it was difficult to rule out a recurrent immature teratoma. Diagnostic exploratory laparoscopic surgery revealed the enlarged tumors that had been detected by the CT scan. Although there were multiple tumors in the pouch of Douglas, we were able to resect all of them laparoscopically. Histological diagnosis of the surgically resected specimens was of a mature teratoma, and so we concluded that this tumor was a GTS. Our experience suggests that laparoscopic surgery is an effective alternative diagnostic and therapeutic approach in cases suspicious of GTS where the disease is disseminated to the peritoneum.
生长性畸胎瘤综合征（GTS）是一种作为恶性生殖细胞肿瘤后遗症出现的罕见临床现象。我们报告了一例20岁女性的病例，该患者在因未成熟畸胎瘤接受保留生育功能手术和化疗后发生了GTS。她在初次手术时接受了左侧输卵管卵巢切除术、右侧卵巢囊肿切除术和肿瘤减灭术。术后组织学报告将肿瘤确定为未成熟畸胎瘤，3级，国际妇产科联盟（FIGO）IIIb期。她随后接受了3个周期由博来霉素、依托泊苷和顺铂组成的化疗。化疗后17个月，随访计算机断层扫描（CT）显示其右结肠旁沟有一增大肿块，Douglas窝有一小的腹膜病变。她的血清甲胎蛋白水平未升高。这些发现符合GTS，但难以排除未成熟畸胎瘤复发。诊断性腹腔镜探查手术发现了CT扫描检测到的增大肿瘤。尽管Douglas窝有多个肿瘤，但我们能够通过腹腔镜将它们全部切除。手术切除标本的组织学诊断为成熟畸胎瘤，因此我们得出结论，该肿瘤为GTS。我们的经验表明，对于怀疑GTS且疾病已播散至腹膜的病例，腹腔镜手术是一种有效的诊断和治疗替代方法。
