林口長庚紀念醫院 外科部 泌尿科系
Testicular Myeloid Sarcoma: A Case Report
Ruei-Je Chang, I-Hung Shao, Chung-Yi Liu, Po-Hung Lin, Kai-Jie Yu, See-Tong Pang, Chun-Te Wu, Cheng-Keng Chuang, Ying-Hsu Chang, Yuan-Cheng Chu, and Hung-Cheng Kan*
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taiwan
Purpose:
Myeloid sarcoma is a kind of solid tumors that are composed of extramedullary, immature white blood cells. It often involves lymph nodes, skin, and soft tissue of head, neck and breast. Therefore, myeloid sarcoma that occurs in uncommon sites causes diagnostic challenges. We describe a male with accidentally-found scrotal mass diagnosed as myeloid sarcoma in testis, a rare tumor (2-8%) presenting in a scarce organ (less than 1%) in the patients of AML.
Materials and Methods:
A 29 year-old male with underlying diseases of relapsed acute myeloid leukemia (M2) s/p FLAG-IDA salvage chemotherapy and post condition chemotherapy with BuCy regimen plus matched sibling donor allogeneic stem cell transplantation presented to urologic clinic with an accidentally found left scrotal tumor. There was no tenderness, lymphadenopathy, lifting pain, erythema and hyperemia. The patient also denied relevant family history. Scrotum echography revealed two heterogeneous internal echogenicity tumors at the size of 2.6 cm and 1.6 cm with hypervascularity.
Results:
The patient underwent left radical orchiectomy. The tumor size is 3*2cm and the feature of firm and solid tumor was noted. Pathology report illustrated that the testicular parenchyma showed diffuse and heavy interstitial infiltration of tumor cells, sparing the seminiferous tubules; moreover, the immunostaining of the tumor cells showed CD117 (+), CD33 (+), CD34 (+), lysozyme (+), MPO (+), OCT-4 (-), and TdT (-), which was compatible with myeloid sarcoma. Local radiation therapy to the contralateral testis and scrotum was arranged after the surgical course.
Conclusions:
It is still difficult to diagnose testicular myeloid sarcoma, which can be an early symptom of relapse of acute myeloid leukemia. However, early diagnosis, surgical intervention and adjustment for chemotherapy or radiotherapy are necessary and beneficial especial to young patients.