Leukemic testicular infiltrates in boys with acute lymphoblastic leukemia (ALL)
Ortega, J.J.; Javier, G.; Torán, N.
Medicina Clinica 78(2): 45-51
1982
ISSN/ISBN: 0025-7753 PMID: 6951106 Document Number: 191011
Boys (85) with ALL were assessed for leukemic testicular infiltrates. The disease was diagnosed between 1976 and 1977 in all the patients, who were all < 14 yr old. Twenty boys (23.5%) presented testicular leukemia during the course of the disease: in 11 of these (13%) this was the 1st relapse (RIT), and in 9 it was either simultaneous with or subsequent to bone marrow or CNS relapse. Incidence of RIT was highest in the patients with the longest hematologic remission and survival time. Correlation was seen between frequency, early RIT and initially high numbers of blasts. RIT was treated with local irradiation and intensified systemic chemotherapy and, in 4 cases, unilateral orchiectomy. Seven patients had subsequent bone marrow relapses and died after a mean period of 6 mo. Two cases are in 2nd continuous remission for > 40 mo. and therapy has been discontinued. Eight of the 9 cases with nonisolated testes relapse died. Bilateral testicular biopsy was practiced in 21 patients in continuous remission for 36 mo., to determine if therapy should be stopped. Leukemic infiltrates were found in 6 boys (27%); if these are added to the patients with testicular infiltrates, a total of 14 of the 35 boys (40%) included in protocol D 74 had some form of testicular leukemia. The actual frequency of RIT in boys with ALL is higher than that of CNS 1st relapses. Bilateral testicular biopsies practiced during or toward the end of the chemotherapy are useful in deciding if therapy should be continued in cases where microscopic infiltrates may be present.