2025 Volume 39 Issue 2 Pages 126-131
Growing teratoma syndrome (GTS), in which tumor markers decrease but any residual tumor enlarges after appropriate chemotherapy for non-seminoma, is associated with a good prognosis if complete resection is performed. We report a GTS patient who underwent an operation focused on the respiratory function on considering tolerance to postoperative chemotherapy. The patient was diagnosed with a primary mediastinal mixed-type germ cell tumor occupying the right thoracic cavity in his 20s, and consequently received three courses of bleomycin+etoposide+cisplatin (BEP) therapy. The tumor was 13 cm in diameter before chemotherapy but increased to 15 cm after chemotherapy, widely adjacent to surrounding organs such as the bony thorax, interlobar pulmonary artery, right middle lobe, diaphragm, and pericardium. After 2 months of chemotherapy, clamshell thoracotomy was performed for resection of the anterior mediastinal tumor with reconstruction of the diaphragm and pericardium, and decortication of the right middle lobe for preservation of respiratory function. Postoperative histopathological examination showed no evidence of malignancy and the right middle lobe, which was compressed by the tumor, was successfully expanded and the respiratory function was improved. Tumor markers decreased to normal after surgical resection and postoperative chemotherapy, and the patient has survived without recurrence for 4 years since surgery.
