{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:59:19Z","timestamp":1785473959967,"version":"3.56.0"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intracranial growing teratoma syndrome (iGTS) is characterized by paradoxical tumor enlargement despite normalization of tumor markers during treatment of germ cell tumors. Its recognition is critical, particularly in the suprasellar region where mass effect can lead to significant morbidity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report two pediatric patients with suprasellar mixed germ cell tumors treated with alternating etoposide\u2013cisplatin and ifosfamide\u2013etoposide chemotherapy. In both cases, serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (\u03b2-HCG) levels declined markedly during treatment; however, clinical deterioration and radiologic tumor enlargement occurred. Surgical resection revealed mature teratoma in both cases, confirming classic iGTS after histopathologic review. Gross total resection was achieved in both cases, followed by completion of chemotherapy and craniospinal irradiation. At follow-up, both patients remained in remission but developed permanent hypothalamic\u2013pituitary dysfunction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>These cases illustrate a clear dissociation between biochemical response and local mass enlargement, consistent with classic iGTS in both patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Declining tumor markers should not be interpreted as reassurance in the presence of worsening symptoms or tumor enlargement. Early surgical intervention should be considered in selected patients to relieve mass effect and potentially reduce long-term morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1871160","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:24:53Z","timestamp":1785471893000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Intracranial growing teratoma syndrome in two children with suprasellar mixed germ cell tumors: implications for the timing of surgery"],"prefix":"10.3389","volume":"16","author":[{"given":"Qizi","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Hematology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Oncology, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Hematology, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Oncology, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Oncology, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Oncology, Children\u2019s Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1177\/0883073818772470","article-title":"Central nervous system germ cell tumors: A review of the literature","volume":"33","author":"Kong","year":"2018","journal-title":"J Child Neurol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2008-0037","article-title":"Pediatric central nervous system germ cell tumors: A review","volume":"13","author":"Echevarr\u00eda","year":"2008","journal-title":"Oncologist"},{"key":"B3","doi-asserted-by":"publisher","first-page":"494","DOI":"10.4143\/crt.2016.129","article-title":"Nationwide population-based incidence and survival rates of Malignant central nervous system germ cell tumors in Korea, 2005-2012","volume":"49","author":"Lee","year":"2017","journal-title":"Cancer Res Treat"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19821015)50:8<1629::aid-cncr2820500828>3.0.co;2-1","article-title":"The growing teratoma syndrome","volume":"50","author":"Logothetis","year":"1982","journal-title":"Cancer"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-020-03486-9","article-title":"Intracranial growing teratoma syndrome (iGTS): An international case series and review of the literature","volume":"147","author":"Michaiel","year":"2020","journal-title":"J Neuro-Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-010-0238-1","article-title":"Intracranial growing teratoma syndrome: Clinical characteristics and treatment strategy","volume":"101","author":"Kim","year":"2011","journal-title":"J Neuro-Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3969\/j.issn.1672-6731.2024.10.002","article-title":"Treatment of pediatric intracranial germ cell tumors: Tiantan experience","volume":"24","author":"Li","year":"2024","journal-title":"Chin J Contemp Neurol Neurosurg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3171\/2009.1.peds0857","article-title":"Intracranial growing teratoma syndrome mimicking tumor relapse: A diagnostic dilemma","volume":"3","author":"Kong","year":"2009","journal-title":"J Neurosurg Pediatr"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-014-2396-5","article-title":"The pathogenesis of intracranial growing teratoma syndrome: Proliferation of tumor cells or formation of multiple expanding cysts? 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