NPD64: Nontraumatic Page kidney– A case report and literature review
林口長庚紀念醫院 外科部 泌尿科系
Testicular Leukemia: A Case Report
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taiwan
Background:
Swollen testicles can be a symptom of various diseases, including malignancy, inflammatory diseases, trauma, hydrocele, varicocele, spermatocele, and inguinal hernia. Leukemic involvement of the testes is rare and mostly occurs in cases of acute lymphocytic leukemia (ALL). In adults, only 0.5% of testicular tumors are caused by leukemia infiltration. Differentiating between testicular involvement of leukemia and common inflammatory diseases of the testes can be difficult, as they can present similar features such as hypervascularity under scrotal sonography. It is important for individuals to be aware of testicular involvement of leukemia, as it is a rare but serious disease that requires prompt diagnosis and treatment.
Case Presentation:
A 66-year-old man with a previous diagnosis of myeloid leukemia cutis presented to the urology clinic with left testicular swelling that had been ongoing for 3 months. Physical examination revealed that the left testis was 8 cm in length, had a hard texture, and was slightly tender. Computerized tomography (CT) scan showed an enlarged and homogeneous left testis, while a testicular ultrasound revealed hypervascularity. Tumor markers, such as PSA, AFP, and beta-hCG were normal. Due to the patient's previous myeloid leukemia cutis, testicular leukemia was highly suspected, so left radical orchiectomy was performed. The pathological report revealed diffuse involvement of leukemia in the testicular parenchyma, which suggested a bone marrow biopsy for tumor origin survey. The biopsy revealed acute myeloblastic leukemia (AML) with CD56 expression. Based on this evidence, acute myeloid leukemia with skin and testicular involvement was diagnosed. The patient received chemotherapy for AML treatment but unfortunately experienced an AML relapse one year later and passed away due to sepsis under chemotherapy-induced immunosuppression status.
Conclusions:
Testicular involvement of acute myeloid leukemia is a rare extramedullary myeloid tumor associated with a poor prognostic factor for myeloid tumors. Some studies suggested that orchiectomy must be performed for testicular involvement of acute myeloid leukemia due to the vascular barrier that impedes the curative chemotherapy. Adjuvant chemotherapy should also be performed for systemic treatment. Early diagnosis, surgeries, and chemotherapies are necessary for patients with testicular involvement of acute myeloid leukemia.