[size=20px]A three year old boy presents with a left retroperitoneal mass measuring 8 cm. Two years ago he underwent resection of a 4 cm mass from the same area with pathology consistent with immature teratoma. Current laboratory investigation reveals an elevated BhCG < 0.5 mIU/mL, and an alpha fetoprotein of 112 ng/mL. What is the best next step in this boy’s management?

 

a US directed needle biopsy of mass

 

b Treat area with proton beam radiation

 

c Complete removal of mass

 

d Open wedge biopsy of mass

 

e Administer platin-based chemotherapy[/size]

C complete removal of the mass

E

C

C

C

C

D

E​​​​

C

Correct answer

C Complete removal of mass

 

Immature teratomas may be noted in any location. These tumors require complete surgical resection, since they do not respond to chemotherapy even when presenting with slightly elevated afp. They may also recur, and again, even with mildly elevated afp or BhCG, are best treated with complete surgical resected as are unlikely to have a favorable response to platin-based therapies.

 

For ovarian immature teratoma, as with any ovarian mass, it is critical to obtain proper surgical staging when resecting an ovarian mass. Collecting peritoneal fluid, or peritoneal washings if no fluid present, for cytology is imperative. Inspection of the peritoneal surfaces including the diaphragm, the omentum and inspection of the contralateral ovary are also important, and suspicious lesions should be biopsied. Treatment of ovarian immature teratoma remains unresolved. Data in adult studies suggest that platin-based chemotherapy should be given to all patients with tumor stage greater than FIGO stage IA, grade 1 tumors. However, in children, data indicate that complete resection of immature teratoma of the ovary will likely result in a cure, but these children require close followup.