曾世一¹,呂硏嫚²,錢祖明¹,柯宏龍¹, 黃俊農^1,3,李經家¹

¹高雄醫學大學 附設中和紀念醫院 泌尿科

²高雄市立小港醫院

³高雄市立大同醫院

Shih-I Tseng¹, Yen-Man Lu², Tsu-Ming Chien¹, Hung-Lung Ke¹, Chun-Nung Huang^1,3

Ching-Chia Li¹

¹Division of Urology,

Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

²Divison of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan

³Divison of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

 

 

This 69 years old man was a case of acute myeloid leukemia (AML) with initial history of enlarged bilateral testis lasted for two weeks. The investigation at the emergent department where the case was first seen included a Computed Tomography, which detected swelling of scrotum wall with Fournier’s gangrene. For this reason, the patient emergency operation was arranged. The complete blood count showed leukocytosis, anemia and severe thrombocytopenia. Left orchiectomy was then performed and the pathologic report showed infiltrating tumor cells bearing pleomorphic and vesicular nuclei and occasional nucleoli in a necrotic background. The tumor cells are immunoreactive for CK34, MPO, and CD68, but negative for CD20, CK, CD30, PLAP, and WT-1. The features suggest of myeloid sarcoma. Unfortunately, the left testis showed gangrene change after 7days of first operation. Therefore, the patient underwent left orchiectomy. The pathologic report was also the same. A bone marrow smear showed that near hypocellular marrow with decreased megakaryocyte. Blast cells was counted as 25% with a myeloid origin. Chemotherapy and extensive abdominal radiotherapy were suggested, but the patient refused. Myeloid sarcoma can occur at any age, though it is usually happened among young adults. The most common affected sites are bone structures, central nervous system, soft tissues of the head and neck, skin, lymph nodes and breasts. Initial presentation of AML with involvement of the testicles, as mentioned in the present case, is relatively rare. In conclusion, despite the rarity of myeloid sarcoma, it should be taken into consideration in the diagnosis of undifferentiated neoplasia. A rapid diagnosis and treatment regardless the unsatisfactory response with frequent and evolution to acute leukemia.