Bleomycin/cisplatin/etoposide

Abstract

Growing teratoma syndrome secondary to recurrent teratoma: case report A man in his 50s [age at the time of reaction onset not clearly stated] developed growing teratoma syndrome secondary to recurrent teratoma following treatment with bleomycin, cisplatin and etoposide for left testicular cancer. The man, who had left testicular cancer treated with chemotherapy including bleomycin, etoposide and cisplatin, radiotherapy, retroperitoneal lymph node dissection and partial left nephrectomy in 1992. At the age of 56-years, he presented to hospital with complaints of left lower abdominal mass for 3–5 years, associated with ulceration and active drainage. He was asymptomatic with βhCG and α-fetoprotein levels within reference ranges. Inspection of abdomen showed well-healed midline scar with bilateral incisional hernias and a 10 x 8cm mass in the left lower quadrant firm and fixed to the abdominal wall. Also, an open lesion characterised by yellow, non-purulent drainage was observed in the left lower quadrant. A CT imaging of abdomen and pelvis with contrast showed a multiloculated large cystic mass in the left inguinal canal measuring 11 x 7 x 7.7cm, along with a similar soft tissue nodule in the right inguinal area. A right retroperitoneal soft tissue mass in the mid abdomen was also identified, measuring 3.3 x 4.2 x 5.7cm. Changes of prior left nephrectomy and orchiectomy consistent with treatment of previous left-sided testicular cancer were also observed. Biopsy of right retroperitoneal mass showed squamous cell lined cystic lesion followed by left lower quadrantabdominal mass excision and complex wound closure. Thus, an elliptical incision was made in the left groin incorporating the lesion, and subcutaneous flaps were created. Dissection was carried down to fascia where the mass extended into inguinal ring and the lower edge of the external oblique aponeurosis, extending into the abdomen. The mass was excised and noted to be multiloculated and heterogeneous in consistency. The fascia and peritoneum that was adhered to the mass were then resected. A superficial inguinal lymph node was excised and sent to pathology as a separate specimen, and no other inguinal or femoral enlarged lymph nodes were noted. Final pathology results demonstrated a mucinous cystic neoplasm with a negative lymph node for malignancy, consistent with potential spermatic cord mucinous cystadenoma. The presence of retroperitoneal and contralateral inguinal masses; however, with history of teratoma raised suspicion of bilateral mucinous cystadenoma vs residual/recurrent teratomatous component of testicular tumour. Based on the his history and laboratory findings, a diagnosis of recurrent teratoma was favored. He was asked to follow up with surgery 2 weeks after the procedure. During follow-up, he denied any new onset of symptoms and was deemed to be experiencing appropriate postoperative recovery. It was noted that he developed recurrent teratoma secondary to chemotherapy, which further led to the development of growing teratoma syndrome.