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Ovarian Growing Teratoma Syndrome With Spuriously Elevated α-Fetoprotein.

Case Report A previously well 21-year-old woman underwent an exploratory laparotomy for an ovarian mass found after presentation with subacute pelvic pain. During surgery, a 120 95 80 mm craggy mass with an irregular surface was found in the left ovary, and a left salpingo-oophorectomy was performed. Inadvertent cyst rupture occurred intraoperatively. No other intra-abdominal disease was evident. Preoperative tumor markers revealed elevations of -fetoprotein (AFP; 86 kU/L), and CA-125 (140 kU/L). Beta human chorionic gonadotropin, inhibin, and carcinoembryonic antigen were normal. Microscopy revealed features of immature teratoma, with immature mesenchymal tissues, and mature and immature neural elements (Fig 1). Immature neural tissue was present in multiple tissue sections, up to 5 low-power fields/section, equating to grade 3 in a three-tiered system, and high grade in a two-tiered system. Clinicopathologic review assigned a diagnosis of stage IC high-grade immature teratoma. Adjuvant chemotherapy was commenced 6 weeks postoperatively, but after two cycles of etoposide (100 mg/m per day for 5 days) and cisplatin (20 mg/m per day for 5 days), an incomplete tumor marker response was noted, with AFP having increased and plateaued around 20 kU/L. Computed tomography (CT) revealed a hepatic mass measuring 28 27 mm (Fig 2), and a positron emission tomography scan revealed no [F]fluorodeoxyglucose–avid disease. A preoperative CT scan had shown no abnormality apart from the left adnexal mass. The decision was made to proceed to a further laparotomy, at which a 30 36 mm nodule was found on the serosal surface of the right dome of the liver without parenchymal involvement, as well as smaller nodules on the right hemidiaphragm and right pelvic peritoneum. All macroscopic tumor was completely resected. Pathology revealed only mature teratoma, and immunohistochemistry was negative for AFP. After surgery, the AFP normalized. An additional cycle of etoposide and cisplatin was administered and was associated with a transient rise in AFP level (Fig 3; VATS, video-assisted thoracoscopic surgery),