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Mediastinal Teratoma — SCE Medical Oncology MCQ

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HardSarcomaMediastinal TeratomaSCE Medical Oncology

During platinum chemotherapy for a primary mediastinal non-seminomatous germ-cell tumour, AFP and hCG normalise but the residual anterior mediastinal mass enlarges and contains increasing fat and calcification. Biopsy shows mature teratoma. What is the next disease-directed step?

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Reveal the answer and explanation

Correct answer: B — Refer for complete resection in a high-volume thoracic germ-cell tumour centre

Explanation lettering: C = shown as A · E = shown as B · A = shown as C · B = shown as E

E is correct. Enlargement during or after chemotherapy, normalising markers and mature-teratoma histology define growing teratoma syndrome. Mature teratoma is resistant to chemotherapy and radiotherapy, while continued growth can compress mediastinal structures and undergo malignant transformation; complete surgical resection offers durable control. Continuing or escalating cytotoxic treatment does not eradicate the mature component. Marker normalisation does not justify observation when the mass is enlarging, and a twelve-month delay may make a technically demanding resection impossible. Surgery should be planned early in an experienced centre because major vascular, pericardial or pulmonary resection may be required.

Reference: Mediastinal growing teratoma syndrome review: https://pmc.ncbi.nlm.nih.gov/articles/PMC8841536/