Clinical insights from the management of a giant immature teratoma in an infant—a case report

The article discusses a rare case of a giant immature teratoma (IMT) in an infant, highlighting the challenges in diagnosing and managing this type of germ cell tumor that arises from abnormal embryonic cell development. Teratoma growth syndrome represents a rare clinical manifestation, posing significant challenges in differential diagnosis, particularly when distinguishing it from peritoneal gliomatosis or progressive germinoma. In essence, growing teratoma syndrome (GTS) constitutes a distinct and intricate clinical entity that requires meticulous monitoring and management to enhance patient outcomes. The patient was a male infant, presented with a palpable mass in the upper abdomen at 4 months of age. Initial ultrasound and elevated serum alpha-fetoprotein (AFP) levels suggested a retroperitoneal teratoma. After surgery, the diagnosis was confirmed as an IMT [World Health Organization (WHO) grade III]. Despite initial chemotherapy with BEP (bleomycin, etoposide, and cisplatin) and TIC (nab-paclitaxel, ifosfamide, and carboplatin) regimens, the tumor continued to grow, and the patient experienced GTS. A second surgery was performed, and the patient was subsequently treated with TCAV (nab-paclitaxel, cyclophosphamide, epirubicin and vincristine) and TIC chemotherapy, leading to normalization of AFP levels and no evidence of disease over a 4-year follow-up. GTS is a rare clinical manifestation that presents substantial challenges in differential diagnosis, particularly in distinguishing it from conditions such as peritoneal gliomatosis or progressive germinoma. Fundamentally, this syndrome represents a unique and complex clinical entity necessitating careful monitoring and management to improve patient outcomes.