1. Growing Teratoma Syndrome (GTS) is a rare entity which consists of germ cell tumors that grow following chemotherapy despite complete eradication of the malignant cells combined with normal tumour markers 1. They can metastasize to any site, particularly the retroperitoneum, mediastinum, and pelvic region. It typically affects young adults and adolescents. Conclusions Growing Teratoma Syndrome following Primary Ovarian Immature Teratoma: A Case Report Shahi MSJR 1, Alam AMMS 1 1. Ahsania Mission Cancer & General Hospital, Uttara, Dhaka, Bangladesh Logo Bibliography Considering the general condition of the patient she was thoroughly investigated to assess the extent of the disease & to make a therapeutic work up. CECT scan revealed residual disease within the pelvis indenting the bladder and abutting the adjacent bowel loops although all the relevant markers were within normal limit. Colonoscopy report revealed extra-luminal growth in the rectum. After evaluating all the suggested investigations the patient underwent laparotomy with complete excision of the tumour under care of a colorectal surgeon. Histopathology report of excised mass revealed Mature Teratoma without any presence of immature cells. 1.Logothetis CJ, Samuels ML, Johnson DE. The growing teratoma syndrome. cancer. 1982;50:1629–35 2.Spiess PE, Kassouf W, Brown GA, Kamat AM, Liu P, Gomez JA, et al. Surgical Management of Growing Teratoma Syndrome: The M. D. Anderson Cancer Center. Experience J Urol. 2007;177:1330–4. 3.Gorbatiy V, Spiess P, Pisters L. The Growing Teratoma Syndrome: Current review of the literature. Indian Journal of Urology. 2009;25(2):186-189. Histopathology slide was reviewed along with IHC panel. Slides shows solid-cystic tumour with the cystic spaces lined with different types of epithelia and stroma showed islands of cartilage, lobules of adipose tissue and squamous tissue with keratin pearl formation. Biomarker expression was Pan-Cytokeratin positive, Desmin positive, S100 positive. This was consistent with mature teratoma. PET scan revealed absence of any hyper metabolic areas in the body. The main challenge is the accurate diagnosis of this condition in the young patient in order to avoid misdiagnosis of recurrence, and excessive courses of chemotherapy or radical surgery. GTS may occur several years after diagnosis of the primary tumor. Very few cases are reported on young Asian women. Malignant transformation has been reported up to 3 %3. GTS has an overall good prognosis with only a few reported deaths. The five years survival rate is 89 %3. Good treatment outcomes are dependent on the following five steps 3 : (1)Awareness of this condition, (2)Vigilant imaging of patients on chemotherapy (3)Early recognition of the paradoxical response of disease to chemotherapy (enlarging tumors and normal serum tumor markers), (4)Early diagnosis and, finally, (5)Prompt and complete surgical resection of tumors. If we can follow the above five steps, the patient may have a very good prognosis. Background Logo Case Presentation A 26 year old, married, female first presented to a Gynaecologist with gradual abdominal distension and dull aching pain in lower abdomen, of 6 months duration. The patient was para one with history of having regular menstrual cycle. On examination patient was mildly anemic, with moderate ascites. Malignant cells were absent in cytological study of ascitic fluid. CECT scan report revealed left sided Tubo- ovarian mass. Then patient underwent Total Abdominal Hysterectomy with bilateral Salpingo- oophorectomy. Per operative findings were cauliflower like mass about 18 x 16 cm extending from the left ovary up to the epigastrium. Rt sided ovary was cystic. Histopathology report revealed Immature Teratoma, Grade II. It contained islands of squamous cells, immature cartilage, bone, glandular tissue, and immature neural tube. Although β-HCG and CA-125 were within normal limit, α-Feto Protein was raised (137ng/ml). The patient received 4 cycles of chemotherapy with BEP (Bleomycin, Epirubicin, Cisplatin) regimen. After that residual disease was found in CECT scan although all the relevant markers were within normal limit. Then she was given 2 cycles of chemotherapy with EP (Epirubicin, Cisplatin) regimen. Discussion We stress the need for early recognition and treatment of GTS to avoid the subsequent morbidity and mortality associated with it. Although GTS has an excellent prognosis when completely resected, it is essential that the patient should have regular follow-up with serum tumor markers and imaging. After the PET scan and IHC report patient was kept on follow-up. Patient remained with no recurrence at the time of this report, which is 6 months post-surgery.