Coexisting growing teratoma syndrome and gliomatosis peritonei following ovarian immature teratoma: a case report and literature review

Abstract

Background/aim: Growing teratoma syndrome (GTS) is marked by the reduction in serum tumor markers, despite the growth of a benign mature teratomatous mass after chemotherapy treatment for germ cell tumors. Gliomatosis Peritonei (GP) is often seen with ovarian teratomas, involving the spread of mature glial tissue on the peritoneum. The coexistence of GP with GTS following treatment for ovarian immature teratoma (IMT) is particularly rare with about 20 cases reported thus far.Case: A 25-year-old patient underwent surgical removal of an adnexal mass. On paraffin pathology, she was deemed to have stage III A grade 3 ovarian IMT with parametrial involvement. After receiving 2 cycles of BEP chemotherapy, imaging showed the appearance of new lesions adjacent to the liver and on the pelvic peritoneum. She underwent a second fertility sparing surgery and paraffin examination revealed mature teratoma within the removed specimen. The resected pelvic peritoneum revealed mature glial tissue nodules consistent with GP.Conclusion: The coexistence of GP with GTS after ovarian IMT surgery poses a diagnostic challenge in the differentiation between malignant and benign components, which is crucial for avoiding unnecessary aggressive treatments. The recognition of such cases may enable the employment of fertility sparing surgery in the treatment of these patients.