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Growing Teratoma Syndrome of the Liver: Treatment with Living Related Donor Liver Transplantation

¹ Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213.
² Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213.

View larger version (121K): [in a new window]   Fig. 1A. —24-year-old man with end-stage liver disease resulting from extensive hepatic metastases from primary nonseminomatous testicular germ cell tumor who had undergone prior radical orchiectomy, right nephrectomy, and retroperitoneal lymph node resection. Sonogram of left hepatic lobe shows multiple cystic masses of varying sizes (arrows) in background of normal liver parenchyma.

View larger version (122K): [in a new window]   Fig. 1B. —24-year-old man with end-stage liver disease resulting from extensive hepatic metastases from primary nonseminomatous testicular germ cell tumor who had undergone prior radical orchiectomy, right nephrectomy, and retroperitoneal lymph node resection. Unenhanced axial CT image of upper abdomen shows large bilobar hepatic masses and retroperitoneal lymph nodes with cystic (solid straight arrows) and solid (arrowheads) components. Coarse amorphous calcification is evident (curved arrow). Left renal vein (open arrows) is displaced anteriorly by large paraaortic lymph node mass.

View larger version (120K): [in a new window]   Fig. 1C. —24-year-old man with end-stage liver disease resulting from extensive hepatic metastases from primary nonseminomatous testicular germ cell tumor who had undergone prior radical orchiectomy, right nephrectomy, and retroperitoneal lymph node resection. Contrast-enhanced axial CT image of upper abdomen reveals large discrete and confluent masses in liver with cystic (short straight arrows) and solid components showing heterogeneous enhancement and normal intervening liver parenchyma. Large paraaortic lymph node mass (long straight arrows) shows calcification and is displacing left renal vein (curved arrows) anteriorly.

View larger version (124K): [in a new window]   Fig. 1D. —24-year-old man with end-stage liver disease resulting from extensive hepatic metastases from primary nonseminomatous testicular germ cell tumor who had undergone prior radical orchiectomy, right nephrectomy, and retroperitoneal lymph node resection. Photograph of gross specimen of resected hepatic mass shows mixed morphology of tumor, with cystic component (left) adjacent to more solid component consisting of cluster of grapelike nodules (right).

View larger version (156K): [in a new window]   Fig. 1E. —24-year-old man with end-stage liver disease resulting from extensive hepatic metastases from primary nonseminomatous testicular germ cell tumor who had undergone prior radical orchiectomy, right nephrectomy, and retroperitoneal lymph node resection. Photomicrograph of tumor specimen shows portion of liver (L) with cysts (c) lined by glandular (straight arrows) and squamous (curved arrow) epithelium filled with keratin pearl (arrowhead). (H and E, x 200)

View larger version (129K): [in a new window]   Fig. 1F. —24-year-old man with end-stage liver disease resulting from extensive hepatic metastases from primary nonseminomatous testicular germ cell tumor who had undergone prior radical orchiectomy, right nephrectomy, and retroperitoneal lymph node resection. Four-month follow-up contrast-enhanced CT image of abdomen shows regeneration of transplanted right hepatic lobe and no evidence of recurrence. Gastrohepatic lymph nodes (arrows) have decreased in size as compared with an early postoperative scan (not shown). These nodes did not show evidence of disease on frozen section during initial transplantation.

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