Epure Andrei, Pop C Florin, Juravle Ciprian, Grosu Florin, Naicu Carmen
Department of Radiology, Sibiu, County Emergency Hospital, 540245 Sibiu, Romania.
Department of Surgery, Jules Bordet Institute, Université Libre de Bruxelles, 90 Rue Meylemeersch, 1070 Brussels, Belgium.
Diagnostics (Basel). 2024 Apr 23;14(9):875. doi: 10.3390/diagnostics14090875.
Acute lymphoblastic leukemia (ALL) is a malignant disorder of lymphoid progenitor cells that affects both pediatric and adult populations. Although isolated testicular or any other organ recurrence can occur in the pediatric population, it is rare in adults. We present images for an atypical case of the late testicular recurrence of acute lymphoblastic leukemia in a 56-year-old man previously diagnosed with ALL pro-T who was in remission following polychemotherapy (GMALL 2013 protocol) and the allotransplantation of peripheral blood stem cells from a related donor. Five years later (2022), the unilateral testicular relapse of ALL was suspected by imaging and diagnosed by immunophenotyping from sperm fluid infiltrated with atypical cells with an immunophenotype concordant with that of the underlying disease (ALL T). Bone marrow aspiration and biopsy showed no evidence of systemic leukemia relapse. Testicular ablation or chemotherapy and irradiation were considered. Given the strictly testicular relapse, orchiectomy would have been useful, but given the abdominal adenopathy, a chemotherapy course with HyperCVAD Block A was first required. Testicular relapse can occur at any age, and the recognition of this is important as it may be the first manifestation of systemic relapse.
急性淋巴细胞白血病（ALL）是一种影响儿童和成人的淋巴祖细胞恶性疾病。虽然在儿童群体中可发生孤立性睾丸或其他任何器官复发，但在成人中罕见。我们展示了一名56岁男性急性淋巴细胞白血病晚期睾丸复发的非典型病例的影像资料，该男性此前被诊断为ALL pro-T，在接受多药化疗（GMALL 2013方案）及来自相关供体的外周血干细胞同种异体移植后处于缓解期。五年后（2022年），通过影像学怀疑ALL单侧睾丸复发，并通过对浸润有非典型细胞的精液进行免疫表型分析确诊，其免疫表型与基础疾病（ALL T）一致。骨髓穿刺和活检未显示系统性白血病复发的证据。考虑进行睾丸切除或化疗及放疗。鉴于严格的睾丸复发情况，睾丸切除术可能会有用，但鉴于腹部淋巴结肿大，首先需要进行一个疗程的HyperCVAD A方案化疗。睾丸复发可发生于任何年龄，认识到这一点很重要，因为它可能是系统性复发的首发表现。
