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"Growing teratoma syndrome" is a rare and often unrecognized complication of nonseminomatous germ cell tumors of the testis. It is defined by enlarging residual masses, frequently retroperitonal, composed exclusively by teratoma, during the course of chemotherapy. Complications of this syndrome are due to masses compression. Malignant transformation is also possible. "Growing teratoma syndrome" has a good prognosis when cured by complete surgical excision of the tumoral masses. We report the case of a "growing teratoma syndrome" presenting as a retroperitoneal mass occurring in a patient previously treated by orchiectomy and chemotherapy for a nonseminomatous mixed germ cell tumors of the testis without teratomatous component., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Brain metastasis of choriocarinoma is uncommon. These tumors develop in women of childbearing age and commonly produce signs and symptoms of subarachnoid hemorrhage, intracerebral hemorrhage, or brain tumor. Diagnosis can be established by histologic study of operative swabs and bioassay of the patient's blood, urine and cerebrospinal fluid for chorionic gonadotropin. This condition is highly chemo- and radiosensitive. We report the case of a 36-year-old woman with intracranial neoplastic fistulae. Rupture occurred 3 days after spontaneous abortion at 3 months of pregnancy. The patient presented with hemiplegia, aphasia and unclear consciousness. Left fronto-parietal hematoma was diagnosed on the CT scan, and cerebral angiography showed an arteriovenous intracranial fistulae. The hematoma and angioma were surgically removed successfully. The histological examination showed a metastatic choriocarcinoma. Surgery was followed by chemotherapy and radiotherapy. After 6 years of follow-up, complete remission has been obtained.

We report three cases about the diagnostic imaging features of mediastinal choriocarcinoma and during follow up. Computed tomography proved to be more accurate than plain X ray to show the topography and volume of the mediastinal mass hence providing a better approach for biopsy and surgical ablation of the residual tumoral tissues. However, CT cannot differentiate fibrous tumoral remnants from active malignancies and beta HCG is an important tumoral marker in the follow up.

Cis-diamminated-dichloroplatinum is an effective drug in the treatment of testicular dysembryomas and choriocarcinomas. It may obtain results in cases resistant to combinations of drugs already known as being effective against such tumours. It is thus worthy of integration into treatment protocols for forms of these tumours with a poor or reserved prognosis (cases with metastases or lymph node involvement or with chorial participation).

The first case of placental choriocarcinoma producing clinical hyperthyroidism reported in France is described. Recovery occurred, with disappearance of the choriocarcinoma metastases and hyperthyroidism signs, after chemotherapy alone (vincristine and methotrexate). A review of the seven cases reported in the published literature showed that the hyperthyroidism could be related to the thyroid-stimulating activity of the tumoral gonadotropin (HCG).

As cis diaminedichloroplatinum is active in testicular choriocarcinoma, it was logical to try it for placental choriocarcinoma. This drug has been shown very active on two cases of placental choriocarcinoma resisting to methotrexate and actinomycine D. As cis diaminedichloroplatinum is a very toxic drug, it will be given only in the cases resisting to other and less toxic antimitotics.

Progress in the management of dysembryoma and choriocarcinoma of the testis has been achieved by more effective chemotherapy (particularly since CDDP was introduced) and by precise timing of surgery, occasional radiotherapy and chemotherapy. In their study, the authors have divided the 61 cancers treated into three stages, depending on whether the lesions were limited to the testis (7 patients with choriocarcinoma and 4 with dysembryoma), had invaded the lymphnodes (16 patients with choriocarcinoma and 9 with dysembryoma) or were disseminated (15 patients with choriocarcinoma and 10 with dysembryoma). The prospects of cure are about 90% for stage 1,75% for stage II and 50% for stage III.

Nongestational, pure ovarian choriocarcinoma is decidedly rare; the unequivocal diagnosis is rarely established in women of childbearing age. Differentiation of nongestational from gestational trophoblastic neoplasia is crucial, the prognosis and therapy being distinct in each type. We report a case of primary ovarian, nongestational, pure choriocarcinoma in a 27-year-old woman treated with surgery and aggressive chemotherapy. The distinction of nongestational from gestational choriocarcinoma and its variants, including latent choriocarcinoma, is discussed.

In teratomas with a choriocarcinomatous element, the association with surgery of sequential chemotherapy lasting at least two years would appear to represent an improvement. Definitive conclusions may only be drawn from the study of large series.