Growing Teratoma Syndrome (GTS) was first described in 1976 as chemotherapeutic retroconversion. It is a very rare condition among men and women with appropriately treated germ cell tumours characterized by persistence or development of enlarging masses during or after adjuvant chemotherapy. There have only been less than 80 cases reported in literature thus far. Although the incidence of GTS after testicular non seminomatous germ cell tumours is 1.9 – 7.6%, the incidence after malignant germ cell tumours of the ovary is unknown. However due to increasing awareness regarding this condition, more cases have been reported. We would like to present 3 cases seen over the last year of Growing Teratoma Syndrome.

All 3 cases had a fairly similar history. They were all young girls below 30’s who presented with a complex ovarian mass suspicious of malignancy with raised tumour markers. They all underwent fertility sparing surgery which revealed an early stage germ cell tumour of an immature teratoma. However during adjuvant therapy, 2 of them become symptomatic. Radiological imaging showed new pelvic and abdominal masses which were increasing in size.  This was not in relation to the tumor markers which had normalized. Both girls were offered 2^nd line chemotherapy or surgical intervention. Even on 2^nd line chemotherapy the masses grew and caused compressive symptoms. Thus they opted for debulking surgery. Optimal cytoreduction was achieved in both cases; however the histopathology showed mature teratoma with no evidence of immature component.  They were followed up closely and remain asymptomatic with no evidence of recurrence. The other girl is still under surveillance as she has decline surgery or chemotherapy. 

GTS is a rare entity but should be suspected when tumor masses persist or develop with normal tumor markers during or after adjuvant chemotherapy for non-seminomatous germ cell ovarian neoplasia. Familiarity with GTS may help avoid unnecessary chemotherapy and early intervention when it is still feasible for debulking reducing the risk of complications and morbidity. Optimal cytoreduction at surgery for GTS offers an opportunity for cure.