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Aqil B, Gao J, Rahn HR, Sukhanova M, Lu X, Altman J, Jennings L, Chen Q, Chen YH. Non-leukemic presentation of acute promyelocytic leukemia as a testicular mass with associated non-canonical FLT3 mutation. Leuk Lymphoma 2022; 63:3493-3496. [PMID: 36215147 DOI: 10.1080/10428194.2022.2131425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Barina Aqil
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Juehua Gao
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Heidi R Rahn
- Winfield Pathology Consultants, Northwestern Medicine, Winfield, IL, USA
| | - Madina Sukhanova
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Xinyan Lu
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jessica Altman
- Department of Medicine, Hematology Oncology Division, Feinberg School of Medicine, Chicago, IL, USA
| | - Lawrence Jennings
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Qing Chen
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Yi-Hua Chen
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Alam S, Palaniyandy V, Thirunavukkarasu C, Kumaresan N. Testicular myeloid sarcoma: a relapse of acute myeloid leukaemia after allogeneic peripheral blood stem cell transplantation- a rare presentation. BMJ Case Rep 2022; 15:e240820. [PMID: 35304354 PMCID: PMC8935182 DOI: 10.1136/bcr-2020-240820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/04/2022] Open
Abstract
Myeloid sarcoma is an uncommon pathological diagnosis of proliferation of blasts of one or more of the myeloid lineages in regions other than the blood and bone marrow. Myeloid sarcoma of the testis after allogeneic bone marrow stem cell transplantation is very rare and only few cases are reported in the literature. It is usually misdiagnosed as malignant lymphoma, particularly with large cell lymphoma, due to similar histological morphology. Due to difficulty in diagnosis, it is suggested that an appropriate panel of immunohistochemical marker studies be performed in conjunction with clinical correlation to avoid misleading diagnosis and improper treatment of patients. We report an interesting case of a 49-year-old man with a diagnosis of acute myelogenous leukaemia. He had undergone allogeneic peripheral blood stem cell transplantation, achieved complete molecular remission and later relapsed with myeloid sarcoma of the testis.
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MESH Headings
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid, Acute/diagnosis
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/therapy
- Male
- Middle Aged
- Neoplasm Recurrence, Local
- Peripheral Blood Stem Cell Transplantation
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/pathology
- Sarcoma, Myeloid/therapy
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Affiliation(s)
- Shanawaz Alam
- Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Velmurugan Palaniyandy
- Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | | | - Natarajan Kumaresan
- Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Thomson A, Timm B, Nazaretian S, Liodakis P, Bolton D. Rare presentation of isolated bilateral testicular myeloid sarcoma: A case report. Urol Case Rep 2021; 36:101585. [PMID: 33552919 PMCID: PMC7856316 DOI: 10.1016/j.eucr.2021.101585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 11/29/2022] Open
Abstract
Myeloid sarcoma (MS) of the testis is a rare soft tissue tumour which can herald the development of acute myeloid leukaemia (AML). The diagnosis of MS requires a high degree of suspicion as appropriate immunohistochemical staining must be performed to yield an early diagnosis. Whilst there is no consensus on treatment on MS involving the testis, most patients undergo orchidectomy and systemic chemotherapy, with or without radiation therapy. Early and aggressive treatment is key to achieving remission. This case report describes a patient with bilateral testicular MS which heralded the development of AML, who underwent induction chemotherapy and achieved remission.
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Affiliation(s)
- Alice Thomson
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
- Corresponding author. Department of Urology, 145 Studley Road, PO Box 5555, Heidelberg, Victoria, 3084, Australia.
| | - Brennan Timm
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Simon Nazaretian
- Clinical Director Anatomical Pathology VIC/SA, Australian Clinical Labs, Australia
| | - Peter Liodakis
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
- North Eastern Urology, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
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An Unusual Manifestation of Blastic Plasmacytoid Dendritic Cell Neoplasm as a Testicular Tumor. Case Rep Pathol 2019; 2019:9196167. [PMID: 31687245 PMCID: PMC6800931 DOI: 10.1155/2019/9196167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/29/2019] [Indexed: 01/25/2023] Open
Abstract
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a clinically aggressive hematologic malignancy arising from precursors of plasmacytoid dendritic cells that represent less than 1% of hematological malignancies. BPDCN initially presents with cutaneous involvement and a characteristic immunophenotype of CD4, CD56, and CD123 co-expression. Upon disease progression, BPDCN shows a strong predilection for bone marrow, peripheral blood, and lymph nodes, whereas manifestations in visceral organs are rare. Significant heterogeneity in clinical presentation and immunophenotypic profile makes BPDCN challenging to diagnose without an integrated approach based on patient history, clinical features, tumor pathology, and comprehensive immunohistochemical studies. Herein we report the first case of relapsed BPDCN manifesting as a unilateral testicular tumor.
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Imataki O, Uemura M, Uchida S, Yokokura S, Takeuchi A, Ishikawa R, Kondo A, Seo K, Kadowaki N. Complete mimicry: a case of alveolar rhabdomyosarcoma masquerading as acute leukemia. Diagn Pathol 2017; 12:77. [PMID: 29096655 PMCID: PMC5669030 DOI: 10.1186/s13000-017-0667-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A small number of rhabdomyosarcoma (RMS) cases involve the bone marrow. A leukemic presentation of RMS has been reported in a few case series, although almost all cases of leukemic RMS are not completely mimicking leukemia. We encountered a case with RMS cell infiltration of the bone marrow that resembled floating hematological cells. CASE PRESENTATION We encountered a rare case of a 15-year-old boy with a 2-week history of left femoral pain. Upon admission, he was afebrile with no other symptoms. No apparent cause of femoral pain was detected on an initial examination. Laboratory findings revealed normal white blood cell (WBC) count and hemoglobin concentration, with a platelet count of 10.3 × 104/μL. WBCs included 2.0% metamyelocytes, 4.5% myelocytes, and 0.5% blasts. Lactate dehydrogenase concentration was 1299 U/L, creatine kinase was 437 U/L, and C-reactive protein was 1.25 mg/dL. Bone marrow aspiration demonstrated hypercellular marrow (nucleated cell count 1.84 × 104/μL) and 89.0% of blast-like cells of all nucleated cells. The proliferating cells were negative for myeloperoxidase and esterase, and strongly positive for CD56. Positron emission tomography exhibited extensive accumulation of 18F-fludeoxyglucose with a SUVmax of 7.09. Magnetic resonance imaging revealed T1-low intensity, gadolinium-enhanced, diffuse, and irregular lesions on his pelvis and bilateral femurs. These laboratory and imaging findings suggested hematological malignancy with diffuse bone involvement, suggestive of acute leukemia. However, the pathological diagnosis of bone marrow and basal penile muscle biopsy was alveolar RMS. Karyotype analysis of bone marrow cells revealed the characteristic translocation of t(2;13)(q35;q14). The final diagnosis was alveolar RMS with massive involvement of the bone marrow and the primary site in the perineal muscles. The tumor cells both of the primary site and bone marrow were positive for myogenin. CONCLUSIONS A literature review found a misdiagnosed case of completely mimicking leukemic RMS as natural-killer (NK)-cell leukemia. Such a misdiagnosis can have critical consequences. We experienced a rare case of alveolar RMS with symmetrical diffuse bone marrow involvement completely masquerading as acute leukemia. The results of a surface marker study showing that the tumor cells had a near NK-cell phenotype were misleading.
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Affiliation(s)
- Osamu Imataki
- Division of Hematology, Faculty of Medicine, Kagawa University, Kagawa, Japan. .,Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Makiko Uemura
- Division of Hematology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shumpei Uchida
- Division of Hematology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shigeyuki Yokokura
- Division of Hematology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akihiro Takeuchi
- Division of Laboratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Ryo Ishikawa
- Department of diagnostic pathology, Kagawa University, Kagawa, Japan
| | - Akihiro Kondo
- Division of Laboratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kayoko Seo
- Division of Laboratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Norimitsu Kadowaki
- Division of Hematology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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6
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Sanei MH, Shariati M. Chloroma of the testis in a patient with a history of acute myeloid leukemia. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:83. [PMID: 28919910 PMCID: PMC5553242 DOI: 10.4103/jrms.jrms_981_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/18/2017] [Accepted: 04/17/2017] [Indexed: 11/04/2022]
Abstract
Chloroma, or granulocytic sarcoma, is a rare extramedullary solid hematologic cancer, found concomitant with acute myeloid leukemia. It is infrequently associated with other myeloproliferative disorders or chronic myelogenous leukemia. Chloroma of the testis after allogeneic bone marrow transplantation is particularly sparsely represented in the literature. It is suggested that an appropriate panel of marker studies be performed along with clinical correlation and circumspection to avoid misleading conclusions. We report an interesting case of a 32-year-old male with a clinical history of acute myelogenous leukemia, postallogeneic peripheral blood stem cell transplantation that was found to have chloroma of the right testis.
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Affiliation(s)
- Mohammad Hossein Sanei
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Matin Shariati
- Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Rajasekaran J, Tripathy J, Vij M, Scott JX. Unusual cause for testicular swelling in a child. BMJ Case Rep 2017; 2017:bcr-2016-217656. [PMID: 28446480 DOI: 10.1136/bcr-2016-217656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Myeloid sarcoma is a rare solid tumour composed of primitive precursors of granulocytic series of white blood cells involving extramedullary anatomic site. Here we report the case of a 10-month-old with testicular swelling, who was finally diagnosed with granulocytic sarcoma. This case demonstrates that Granulocytic sarcoma should be considered as a part of the differential diagnosis for testicular swelling in spite of having normal peripheral counts and absence of hepatosplenomegaly.
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Affiliation(s)
| | - Jigisa Tripathy
- Pediatrics, Sri Ramachandra University, Chennai, Tamilnadu, India
| | - Mukul Vij
- Department of Pathology, Global Health City, Chennai, Tamilnadu, India
| | - Julius Xavier Scott
- Paediatric Hemato-Oncology, Sri Ramachandra University, Chennai, Tamilnadu, India
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8
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Tran CN, Collie AM, Flagg A, Rhee A. Testicular Myeloid Sarcoma: A Rare Manifestation of Acute Myeloid Leukemia in an Infant. Urology 2014; 84:925-7. [DOI: 10.1016/j.urology.2014.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 06/27/2014] [Accepted: 07/01/2014] [Indexed: 11/26/2022]
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9
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Zago LBR, Ladeia AAL, Etchebehere RM, de Oliveira LR. Testicular myeloid sarcoma: case report. Rev Bras Hematol Hemoter 2013; 35:68-70. [PMID: 23580888 PMCID: PMC3621639 DOI: 10.5581/1516-8484.20130018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 12/11/2012] [Indexed: 11/27/2022] Open
Abstract
Myeloid sarcomas are extramedullary solid tumors composed of immature granulocytic precursor cells. In association with acute myeloid leukemia and other myeloproliferative disorders, they may arise concurrently with compromised bone marrow related to acute myeloid leukemia, as a relapsed presentation, or occur as the first manifestation. The testicles are considered to be an uncommon site for myeloid sarcomas. No therapeutic strategy has been defined as best but may include chemotherapy, radiotherapy and/or hematopoietic stem cell transplantation. This study reports the evolution of a patient with testicular myeloid sarcoma as the first manifestation of acute myeloid leukemia. The patient initially refused medical treatment and died five months after the clinical condition started.
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Chen M, Kim Y, Huang Q, Chang K, Gaal KK, Weiss LM. Acute myeloid leukemia with an unusual histologic pattern mimicking metastatic carcinoma in bone marrow: a diagnostic pitfall. J Hematop 2011. [DOI: 10.1007/s12308-011-0090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Thirty-two cases of granulocytic sarcoma (GS) are reported in this paper. Age range was from 16 - 70 years. GS was accompanied by AML in 13 cases, ALL (My+) in one case, CML in 11 cases and MDS in two cases. GS was diagnosed simultaneously with leukemia in five cases and preceded the leukemia in eight. Lymph node and soft tissue were the most commonly detected localizations. Seven cases had first been diagnosed as NHL. Histopathologically blastic, immature and mature variants were found in 11, nine and 11 cases respectively and overall survival was shortest in the blastic type. Myeloperoxidase and lysozyme were found to be positive in 30 and 24 cases respectively. Therapy was radiation in five cases and surgery in three. Systemic chemotherapy was given to the cases. The clinical outcome of the patients after the diagnosis of GS was poor. GS is a unique entity; prognosis is poor but it is important to detect the signaling pathways associated with migration of myeloid cells to the extra-medullary tissues. The critical factors for detecting this interesting tumor are to be aware of this disease, cooperation between clinician and pathologist and the application of special stains to detect the myeloid origin.
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Affiliation(s)
- Semra Paydas
- Department of Oncology, Cukurova University Faculty of Medicine, Adana, Turkey.
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Armstrong MB, Nafiu OO, Valdez R, Park JM, Williams JA, Wechsler DS. Testicular chloroma in a nonleukemic infant. J Pediatr Hematol Oncol 2005; 27:393-6. [PMID: 16012331 DOI: 10.1097/01.mph.0000173847.87539.e0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extramedullary myeloid cell tumors (EMCT) are localized collections of immature myeloid cells that occur outside of the bone marrow. Usually observed concurrently with bone marrow disease, EMCT also may occur in the absence of overt marrow leukemia. In this report, we describe an infant with a testicular mass that was identified as an EMCT after orchiectomy. Unlike the only previously reported case of infantile testicular chloroma, this patient did not exhibit bone marrow disease at diagnosis. Because systemic chemotherapy is considered to be superior to local control (surgery, radiation therapy), the patient was treated with intensively timed induction chemotherapy followed by 3 cycles of maintenance treatment (according to CCG protocol #2891) but no radiation therapy. The patient remains disease-free 18 months after diagnosis.
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Affiliation(s)
- Michael B Armstrong
- Department of Pediatrics, Section of Pediatric Hematology-Oncology, The University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
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Corcoran NM, Tsui A, Costello AJ, Bouchier-Hayes D. Unilateral testicular mass in man with chronic myelomonocytic leukemia: unusual presentation of chronic myelomonocytic leukemia sequela. Urology 2005; 65:1001. [PMID: 15882745 DOI: 10.1016/j.urology.2004.11.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2004] [Revised: 10/20/2004] [Accepted: 11/22/2004] [Indexed: 11/27/2022]
Abstract
Extramedullary myeloid cell tumors are discrete tissue infiltrations by leukemic cells of myeloid lineage. They are more commonly associated with relapsing acute myelogenous leukemia but can occur in myeloproliferative/myelodysplastic leukemia, usually associated with disease acceleration. Although they can occur in any organ, reported testicular infiltration is rare. We describe the clinical presentation of an extramedullary myeloid cell tumor as a unilateral testicular mass in a man with known chronic myelomonocytic leukemia and its histologic diagnosis. To our knowledge, this manner of presentation is unique in this clinical context.
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Affiliation(s)
- Niall M Corcoran
- Department of Urology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Kang SP, Liu DB, Qureshi A, Seiter K. Presentation of extramedullary acute myelogenous leukemia as bilateral testicular masses: response to non-myeloablative allogeneic transplantation. Leuk Lymphoma 2004; 45:1481-3. [PMID: 15359653 DOI: 10.1080/10428190310001653718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We present an unusual case of extramedullary acute myelogenous leukemia (AML) presenting as bilateral testicular masses. The patient subsequently developed diffuse skin lesions and bone marrow involvement. Although he had only a partial response to intensive chemotherapy, the patient obtained a complete remission after non-myeloablative allogeneic transplantation.
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Affiliation(s)
- S Peter Kang
- Department of Medicine, New York Medical College, Valhalla, New York 10595, USA
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Quaranta BP, Halperin EC, Kurtzberg J, Clough R, Martin PL. The incidence of testicular recurrence in boys with acute leukemia treated with total body and testicular irradiation and stem cell transplantation. Cancer 2004; 101:845-50. [PMID: 15305418 DOI: 10.1002/cncr.20413] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The incidence of testicular recurrence of childhood acute leukemia after total body irradiation (TBI) in conjunction with stem cell transplantation (SCT) has been reported to be as high as 24%. The authors studied the incidence of testicular failure in a large series of male patients who underwent SCT using either TBI and a testicular irradiation boost or chemotherapy alone. METHODS One hundred thirty-one boys with either acute myeloid leukemia (AML) or acute lymphocytic leukemia (ALL) were treated with SCT with either TBI with testicular boost (n = 94 patients), TBI without testicular boost (n = 1 patient), or chemotherapy alone (n = 36 patients) between 1991 and 1999. RESULTS The median follow-up was 26.5 months (range, 0.6-99.5 months) from the date of bone marrow infusion. Two patients in the study had a primary testicular failure after TBI with testicular boost followed by an umbilical cord blood transplantation. The first patient had ALL, did not engraft, and was rescued with autologous cells. He developed disease in the testicle 15 months afterward and subsequently died. The second patient had Philadelphia chromosome-positive ALL and developed a testicular recurrence 26 months after SCT. He was treated with orchiectomy, further testicular irradiation, and chemotherapy and remained in complete remission > 3 year after his failure. The incidence of testicular failure in boys who received TBI and testicular irradiation who survived > or = 1 year was 4.2%. There were no primary testicular failures reported in boys who received chemotherapy alone. CONCLUSIONS Boys with AML or ALL had a low incidence of primary testicular failure when they were treated with TBI plus a testicular boost or with chemotherapy alone.
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Affiliation(s)
- Brian P Quaranta
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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