Survival after an antiangiogenetic therapy and surgery in a wide spread growing teratoma originating from a testicular mixed malignant germ cell tumor

Klin Padiatr. 2009 May-Jun;221(3):136-40. doi: 10.1055/s-0029-1220738. Epub 2009 May 12.

Abstract

Growing teratoma is still an often unsolved problem especially in male with mixed malignant GCTs of the testis or the mediastinum. This specific situation with progressive tumor growth and simultaneous normalization of tumor markers during or after treatment of malignant GCTs with teratomatous elements is judged as a fatal situation if this situation can not be controlled by extensive surgery, as teratoma are not sensible to chemotherapy or irradiation. Here, we report the case history of a 17-year old male patient with a testicular malignant GCT and wide spread lymph node metastases, who developed a rapidly progressive growing teratoma within the lymph node metastases. Within the molecular profile of the tumor we could find a cytogenetic picture typically found in malignant adult GCTs. In view of the bulky abdominal, thoracic and cervical metastases and the uncontrolled tumor progression, the situation was considered incurable. However, following an individual treatment attempt, this patient was treated with a four-agent combination of drugs with antiangiogenetic potential as well as low-dose cyclic chemotherapy. This approach resulted in a sustained disease stabilization followed by extensive surgical resection of the metastases. We therefore would like to highlight this treatment approach in unresectable growing teratoma and would like to stimulate further research and collaboration to come to an optimized treatment suggestion for this group of poor prognostic patients.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Angiogenesis Inhibitors / adverse effects
  • Angiogenesis Inhibitors / therapeutic use*
  • Antibodies, Monoclonal / administration & dosage
  • Antibodies, Monoclonal / adverse effects
  • Antibodies, Monoclonal, Humanized
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bevacizumab
  • Combined Modality Therapy
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Endodermal Sinus Tumor / blood supply
  • Endodermal Sinus Tumor / drug therapy*
  • Endodermal Sinus Tumor / mortality
  • Endodermal Sinus Tumor / pathology
  • Endodermal Sinus Tumor / surgery*
  • Follow-Up Studies
  • Humans
  • Interferon alpha-2
  • Interferon-alpha / administration & dosage
  • Interferon-alpha / adverse effects
  • Lymph Node Excision*
  • Lymph Nodes / blood supply
  • Lymph Nodes / pathology
  • Lymphatic Metastasis* / pathology
  • Magnetic Resonance Imaging
  • Male
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Staging
  • Neoplasms, Germ Cell and Embryonal / blood supply
  • Neoplasms, Germ Cell and Embryonal / drug therapy*
  • Neoplasms, Germ Cell and Embryonal / mortality
  • Neoplasms, Germ Cell and Embryonal / pathology
  • Neoplasms, Germ Cell and Embryonal / surgery*
  • Neoplasms, Multiple Primary / blood supply
  • Neoplasms, Multiple Primary / drug therapy*
  • Neoplasms, Multiple Primary / mortality
  • Neoplasms, Multiple Primary / pathology
  • Neoplasms, Multiple Primary / surgery*
  • Recombinant Proteins
  • Reoperation
  • Salvage Therapy
  • Survival Rate
  • Teratoma / blood supply
  • Teratoma / drug therapy*
  • Teratoma / mortality
  • Teratoma / pathology
  • Teratoma / surgery*
  • Testicular Neoplasms / drug therapy*
  • Testicular Neoplasms / mortality
  • Testicular Neoplasms / pathology
  • Testicular Neoplasms / surgery*
  • Thalidomide / administration & dosage
  • Thalidomide / adverse effects
  • Tomography, X-Ray Computed
  • Vinblastine / administration & dosage
  • Vinblastine / adverse effects

Substances

  • Angiogenesis Inhibitors
  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins
  • Bevacizumab
  • Thalidomide
  • Vinblastine