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Acute Lymphoblastic Leukemia with Primary Testicular Involvement in a Pre-pubertal Male: A Case Report

Received: 22 May 2020     Accepted: 10 June 2020     Published: 4 July 2020
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Abstract

Acute lymphoblastic leukaemia is the most common malignancy in paediatric patients; its diagnosis is usually easy to establish as malignant lymphoblasts invade the bone marrow and peripheral blood. Patients with Acute lymphoblastic leukaemia (ALL) may initially present with pancytopenia and a hypoplastic or hyperplastic bone marrow. Fever is common at presentation, and despite neutropenia, sepsis is rarely seen. Other common clinical manifestations include fatigue, pallor, petechiae, bleeding, lymphadenopathy and hepatosplenomegaly. Presentation with primarily testicular disease is exceedingly rare in acute lymphoblastic leukemia. The unusual presentation of a primary left testicular involvement in ALL is being highlighted in this case report. We present an 11 year old boy who presented with fever, generalized body pain, abdominal discomfort as well as left testicular swelling. Bone marrow studies, Full blood count and peripheral blood film appearance were typical of acute lymphoblastic leukaemia. Ultrasound findings showed left scrotal enlargement with reduced and coarse parenchymal echotexture, while cytogenetic studies revealed positive Philadelphia chromosomes. There was good response to standard ALL therapy. Clinical remission with normal left testicular size was noted at the end of induction phase of therapy.

Published in Cancer Research Journal (Volume 8, Issue 2)
DOI 10.11648/j.crj.20200802.14
Page(s) 42-44
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Acute Lymphoblastic Leukemia, Positive Philadelphia Chromosomes, Left Testicular Enlargement

References
[1] The National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries (https://www.cancer.gov/publications/pdq). Last accessed June 5, 2020.
[2] Sherdlow, S. H., Campo, E. Pileri S. A, Harris, N. L. Stein H, et al (2016). World Health Organization classification of tumors of haematopoietic and lymphoid tissues. Blood; 127 (20): 2375–2390.
[3] Kaplan J. A. (2019) Leukemia in Children. Pediatrics in Review. 40 (7): 319-333.
[4] Ashok V, Ranganathan R, Chander S and Sundareshan T. S. (2017). Comparison of Diagnostic Yield of a FISH Panel Against Conventional Cytogenetic Studies for Hematological Malignancies: A South Indian Referral Laboratory Analysis Of 201 Cases. Asian Pac J Cancer Prev. 29; 18 (12): 3457-3464.
[5] Abdolkarimi Babak, Shahriari Mahdi, Zareifar Soheila and Zia Obeydavi (2019) How I Treat Isolated Extra Medullary Acute Lymphoblastic Leukemia? Int J Cancer Res and therapy. 4; 2: 1-2.
[6] Martins A. G, (2018). Testicular Relapse in Acute Lymphoblastic Leukemia (ALL): Guidelines Martins, Journal of Leukemia. 6: 2.
[7] Pui C H. (2018) Is testicular irradiation necessary for patients with acute lymphoblastic leukemia and testicular relapse? Pediatr Blood Cancer. 65: e26977-e26978.
[8] Boddu P, Cameron Yin C, Kanagal-Shamanna R, Tang G, Thakral B, et al (2017). An Unsuspected Finding of t(9;22): A Rare Case of Philadelphia Chromosome-Positive B-Lymphoblastic Lymphoma Case Reports in Hematology. 2017; 4-9.
[9] Binesh F, Yazdi M F, Jenabzadeh A, Hosseini S, Massum R. (2016) Primary Testicular Pre-B Lymphoblastic Lymphoma. APSP Journal of Case Reports. 24; 7 (2): 15-19.
[10] Togo B, Traore F, Doumbia AK, Togo P, Diall H, et al. (2018) Childhood acute lymphoblastic leukemia in sub Saharan Africa: 4 years’ experience at the pediatric oncology unit Bamako, Mali. J Child Adolesc Health. 2 (2): 24-6.
[11] Barredo JC, Hastings C, Lu X, Devidas M, Chen Y, et al. (2018) Isolated late testicular relapse of B-cell acute lymphoblastic leukemia treated with intensive systemic chemotherapy and response-based testicular radiation: A Children's Oncology Group study. Pediatr Blood Cancer. 65: e26928.
[12] Talekar MK, Maude SL, Hucks GE, Hucks GE, Motley LS, et al. (2017). Effect of chimeric antigen receptor-modified T (CAR-T) cells on responses in children with non- CNS extramedullary relapse of CD19+ acute lymphoblastic leukemia (ALL). J Clin Oncol. 35: 10507.
Cite This Article
  • APA Style

    Patrick Olanrewaju Osho, Matilda Adesuwa Osagie Ojo, Eevenly Salawa Osho, Olufunke Caroline Odunlade, Oluwatosin Idowu Oni. (2020). Acute Lymphoblastic Leukemia with Primary Testicular Involvement in a Pre-pubertal Male: A Case Report. Cancer Research Journal, 8(2), 42-44. https://doi.org/10.11648/j.crj.20200802.14

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    ACS Style

    Patrick Olanrewaju Osho; Matilda Adesuwa Osagie Ojo; Eevenly Salawa Osho; Olufunke Caroline Odunlade; Oluwatosin Idowu Oni. Acute Lymphoblastic Leukemia with Primary Testicular Involvement in a Pre-pubertal Male: A Case Report. Cancer Res. J. 2020, 8(2), 42-44. doi: 10.11648/j.crj.20200802.14

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    AMA Style

    Patrick Olanrewaju Osho, Matilda Adesuwa Osagie Ojo, Eevenly Salawa Osho, Olufunke Caroline Odunlade, Oluwatosin Idowu Oni. Acute Lymphoblastic Leukemia with Primary Testicular Involvement in a Pre-pubertal Male: A Case Report. Cancer Res J. 2020;8(2):42-44. doi: 10.11648/j.crj.20200802.14

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  • @article{10.11648/j.crj.20200802.14,
      author = {Patrick Olanrewaju Osho and Matilda Adesuwa Osagie Ojo and Eevenly Salawa Osho and Olufunke Caroline Odunlade and Oluwatosin Idowu Oni},
      title = {Acute Lymphoblastic Leukemia with Primary Testicular Involvement in a Pre-pubertal Male: A Case Report},
      journal = {Cancer Research Journal},
      volume = {8},
      number = {2},
      pages = {42-44},
      doi = {10.11648/j.crj.20200802.14},
      url = {https://doi.org/10.11648/j.crj.20200802.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.crj.20200802.14},
      abstract = {Acute lymphoblastic leukaemia is the most common malignancy in paediatric patients; its diagnosis is usually easy to establish as malignant lymphoblasts invade the bone marrow and peripheral blood. Patients with Acute lymphoblastic leukaemia (ALL) may initially present with pancytopenia and a hypoplastic or hyperplastic bone marrow. Fever is common at presentation, and despite neutropenia, sepsis is rarely seen. Other common clinical manifestations include fatigue, pallor, petechiae, bleeding, lymphadenopathy and hepatosplenomegaly. Presentation with primarily testicular disease is exceedingly rare in acute lymphoblastic leukemia. The unusual presentation of a primary left testicular involvement in ALL is being highlighted in this case report. We present an 11 year old boy who presented with fever, generalized body pain, abdominal discomfort as well as left testicular swelling. Bone marrow studies, Full blood count and peripheral blood film appearance were typical of acute lymphoblastic leukaemia. Ultrasound findings showed left scrotal enlargement with reduced and coarse parenchymal echotexture, while cytogenetic studies revealed positive Philadelphia chromosomes. There was good response to standard ALL therapy. Clinical remission with normal left testicular size was noted at the end of induction phase of therapy.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Acute Lymphoblastic Leukemia with Primary Testicular Involvement in a Pre-pubertal Male: A Case Report
    AU  - Patrick Olanrewaju Osho
    AU  - Matilda Adesuwa Osagie Ojo
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    AU  - Olufunke Caroline Odunlade
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    DO  - 10.11648/j.crj.20200802.14
    T2  - Cancer Research Journal
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    PB  - Science Publishing Group
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    UR  - https://doi.org/10.11648/j.crj.20200802.14
    AB  - Acute lymphoblastic leukaemia is the most common malignancy in paediatric patients; its diagnosis is usually easy to establish as malignant lymphoblasts invade the bone marrow and peripheral blood. Patients with Acute lymphoblastic leukaemia (ALL) may initially present with pancytopenia and a hypoplastic or hyperplastic bone marrow. Fever is common at presentation, and despite neutropenia, sepsis is rarely seen. Other common clinical manifestations include fatigue, pallor, petechiae, bleeding, lymphadenopathy and hepatosplenomegaly. Presentation with primarily testicular disease is exceedingly rare in acute lymphoblastic leukemia. The unusual presentation of a primary left testicular involvement in ALL is being highlighted in this case report. We present an 11 year old boy who presented with fever, generalized body pain, abdominal discomfort as well as left testicular swelling. Bone marrow studies, Full blood count and peripheral blood film appearance were typical of acute lymphoblastic leukaemia. Ultrasound findings showed left scrotal enlargement with reduced and coarse parenchymal echotexture, while cytogenetic studies revealed positive Philadelphia chromosomes. There was good response to standard ALL therapy. Clinical remission with normal left testicular size was noted at the end of induction phase of therapy.
    VL  - 8
    IS  - 2
    ER  - 

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Author Information
  • Department of Haematology & Blood Transfusion, Faculty of Basic Clinical Sciences, University of Medical Sciences, Ondo-City, Nigeria

  • Department of Haematology & Blood Transfusion, Faculty of Basic Clinical Sciences, University of Medical Sciences, Ondo-City, Nigeria

  • Department of Radiology, Faculty of Basic Clinical Sciences, University of Medical Sciences, Ondo-City, Nigeria

  • Department of Paediatrics, Faculty of Clinical Sciences, University of Medical Sciences, Ondo-City, Nigeria

  • Department of Haematology/Virology, University of Medical Sciences Teaching Hospital, Akure, Nigeria

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