Intracranial growing teratoma syndrome (iGTS): an international case series and review of the literature

George Michaiel, Douglas Strother, Nicholas Gottardo, Ute Bartels, Hallie Coltin, Juliette Hukin, Beverly Wilson, Shayna Zelcer, Jordan R. Hansford, Timothy Hassall, Mohamed S. AbdelBaki, Kristina A. Cole, Lindsey Hoffman, Natasha P. Smiley, Amy Smith, Anna Vinitsky, Nicholas A. Vitanza, Avery Wright, Kee K. Yeo, Lionel M.L. ChowMagimairajan I. Vanan, Girish Dhall, Eric Bouffet, Lucie Lafay-Cousin

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Purpose: Intracranial growing teratoma syndrome (iGTS) is a rare phenomenon of paradoxical growth of a germ cell tumor (GCT) during treatment despite normalization of tumor markers. We sought to evaluate the frequency, clinical characteristics and outcome of iGTS in Western countries. Methods: Pediatric patients from 22 North American and Australian institutions diagnosed with iGTS between 2000 and 2017 were retrospectively evaluated. Results: From a total of 777 cases of central nervous system (CNS) GCT, 39 cases of iGTS were identified for an overall frequency of 5%. Pineal region was a more frequent location for iGTS as compared to cases of GCT without iGTS (p < 0.00001). In patients with an initial tissue diagnosis of GCT, immature teratoma was present in 50%. Serum AFP or ßhCG was detectable in 87% of patients (median values 66 ng/mL and 44 IU/L, respectively). iGTS occurred at a median of 2 months (range 0.5–32) from diagnosis, in the majority of patients. All patients underwent surgical resection, leading to gross total resection in 79%. Following surgery, all patients resumed adjuvant therapy or post treatment follow-up for GCT. At a median follow-up of 5.3 years (range 0.2–11.8), 37 (95%) of patients are alive, including 5 with stable residual mass. Conclusion: iGTS occurs in 5% of patients with GCT in Western countries. Tumors of the pineal region and GCT containing immature teratoma appear to be associated with a higher risk of developing iGTS. Complete surgical resection is the mainstay of treatment. Overall survival of patients developing iGTS remains favorable.

Original languageEnglish
Pages (from-to)721-730
Number of pages10
JournalJournal of Neuro-Oncology
Issue number3
StatePublished - May 1 2020


  • CNS
  • Germ cell tumor
  • Growing teratoma syndrome
  • Intracranial


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