A clinical study of testicular relapse in childhood acute lymphocytic leukemia

From January 1984 to June 1991, we studied testicular relapsed patients among 105 cases of acute lymphocytic leukemia in children who were admitted to the Department of Pediatrics and Yonsei Cancer Center, Yonsei University Severance Hospital. The results were as follows: 1) 15 out of 105 (14.4%) cases of acute lymphocytic leukemia were diagnosed as testicular relapse. According to the prevalence by the age groups, there were no patient under 2 years old, 14 out of 73 (19.4%) in 2~9 years old and 1 out of 26 (3.8%) over 10 years old groups. 2) At initial diagnosis of acute lymphocytic leukemia there were significant correlation between testicular relapse and initial lymphadenopathy (p=0.09), but not with WBC count, hemoglobin level, platelet count, hepatomegaly and splenomegaly. 3) Mean duration to testicular relapse from initial diagnosis of acute lymphocytic leukemia was 3.1+/-1.7 years. 4) Among 15 patients, 7 cases combined with bone marrow or central nervous system relapse. Their survival rate was lower than isolated testicular relapse groups. 5) The 5 years survival rate of testicular relapsed patients was 67% after the combinations of chemotherapy, radiotherapy and orchiectomy.

Treatment of testicular relapse in acute lymphocytic leukemia of chilhood / 대한비뇨기과학회지

The incidence of testicular relapse in childhood acute lymphocytic leukemia has been increasing in accordance with the development of effective systemic chemotherapy. Presently as local treatment testicular irradiation is regarded as a reasonable treatment modality. But after bilateral testicular irradiation, the function of Leydig cells as well as Sertoli cells is impaired. Hence, as the survival or acute lymphocytic leukemia (ALL) increases. Many problems will arise. In our experience. we managed 5 patients of unilateral testicular relapse, of whom 3 had unilateral orchiectomy performed only as local treatment and 2 were treated with radiation therapy. Three patients underwent unilateral orchiectomy survived. But, the two patients who were treated with radiation therapy expired. All of them had associated relapse in the other sites. There were 8 bilateral testicular relapses, 7 of whom were treated with radiation therapy. Of them, 1 patient, who had associated relapse in the bone marrow expired. Two patients, clinically showing unilateral relapse had unilateral orchiectomy and biopsy of the contralateral testes. Contralateral biopsy results showed testicular infiltration. Therefore. radiation therapy was given. Of the two cases, 1 had associated relapse in central nervous system and he died. According to our result, the unilateral orchiectomy was no worse than radiation therapy in cases of unilateral testicular relapse. Survival was not significantly affected by treatment modality but by associated relapse. Therefore, for preserving the function of Sertoli cells and Leydig cells, we present the possibility of unilateral orchiectomy in unilateral testicular relapse of ALL.

Testicular Leukemia

Leukemic infiltration of the testes has been relatively rare disease. But increased survival due to advance in the treatment of childhood leukemia has been associated with an increase in incidence of leukemic infiltration of the tests. Six of 66 male children with acute lymphocytic leukemia and 2 of 2 male children with leukemic transformation on non-Hodgkin's lymphoma, who have been admitted to our pediatric department during past 7.5 years period, from January, 1974 to June, 1981 developed testicular leukemia. This represents an incidence of 11.8% and the median age was 6.6 years(9 mo. to 14 yrs). All patients were symptom free despite testicular enlargement. Testicular enlargement was initial presenting manifestation in two patients. The enlargement was unilateral in 5 and bilateral in 3. Initial white blood cell count was greater than 100,000/mm3 in five patients and was less than 10,000/3 in other three. Microscopic findings on specimens were leukemic infiltration mainly in the interstitial spaces and atrophy of spermatogenic cells. Four patients developed testicular relapse during bone marrow remission. Hepatosplenomegaly and lymphadenopathy were present in 5 and 6, and these appeared to imply an increased risk of testicular relapse. The median duration from diagnosis to testicular relapse was 33.5 months(2 mo. to 93 mo.). Three patients developed subsequent relapses(CNS; 2, BM; 1) 1.5 to 26 months after the testicular relapse, the median interval being 14.5 months. Radiotherapy with chemotherapy has resulted clinical improvement, but only one patient showed long survival without relapse.