Growing teratoma syndrome is a rare entity in germ cell tumours where serum tumour markers normalise, but tumour size increases on imaging while under ongoing chemotherapy. It requires complex multidisciplinary management where complete surgical resection is the ultimate aim. Adjunctive procedures are necessary in 23-100% (vascular reconstruction and nephrectomies), which can subsequently lead to considerable morbidity (18-44%). This contemporary series explores this phenomenon when being done in a tertiary centre illustrating multiple treatment approaches, rescue of complications with a multidisciplinary approach.

A single institutional, Retrospective review of patients with a diagnosis of growing teratoma syndrome (GTS) with atleast 6 months follow up was done over the last 5 years.

A total of 12 patients were included. After preoperative rehabilitation, most patients were operated on in CTVS OT with a team of urosurgeon, CTVS surgeons, GI surgeons and thoracic surgeons. All patients had R0 resection. All but one patient were operated on in a single sitting. GI surgeon was involved in 2 cases for the resection of liver lesions and peripancreatic lesions, respectively, while a thoracic surgeon was involved for the resection of mediastinal masses. None of the patients required major vascular reconstruction, and left-sided nephrectomy was required in only one patient (8.3%). None of the patients had clavin-dindo 3 or above complications. The most common postoperative complication was paralytic ileus (4/12), followed by SSI (2/12), which were managed conservatively. One patient had a malignant transformation of neuroectodermal in origin in final pathology. At the end of a one-year follow-up, two patient  had a small recurrence, which is under observation  while one patient underwent redo surgery .

Growing teratoma syndrome are rare but serious clinical entity. Surgery is the mainstay of treatment, hence early recognition of the entity gives the best chance at complete resection. Multidisciplinary approach is essential as there is need for adjunct procedures and this gives the best oncological outcomes.

To achieve the best oncologic outcomes and enhance the effectiveness of treatment in growing teratoma syndrome :
1. Early recognition of the paradox,
2. Completion of initially stage-stratified numbers of chemotherapy courses under thorough monitoring of size and clinical appearance,
3. Multidisciplinary team approach,
4. Complete surgical resection of residual masses.

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