Occult testicular leukemia: Testicular biopsy at three years continuous complete remission of childhood leukemia: A southwest oncology group study

Abstract

, occult testicular leukemia (OTL) was discovered a t three years of continual complete remission (CCR) from the time of diagnosisof acute lymphoblastic leukemia (ALL) in 5 of 59 (8.5%) of males undergoing bilateral wedge testicular biopsy at 1 of 15 participating Southwest Oncology Group (SWOG) institutions. Forty-six of the 54 males with normal biopsies (78% of the total group of 59) have remained free of recurrent ALL at a median of 18 months (range 13 to 23 months) since the biopsy procedure, whereaseight have relapsed for the first time-five bone marrow (BM), one sclera, one simultaneous BM and testes, and one testes-at a median of 12.5 months (range 4 to 22 months) after the normal testicular biopsy. With aggressive therapy after biopsy in the five boys with OTL, one has died 19 months after biopsy (after two BM relapses), one is alive 21 months after biopsy (after two BM relapses), and three are alive and free of recurrent ALL 13, 16, and 19 months, respectively, since the diagnosis of OTL.Cancer 47:470-475, 1981.w I:hHerapy for acute lymphocytic leukemia (ALL) THE DEVELOPMENT of effective chemoof childhood, long-term continual complete remission (CCR) is being attained. In addition to control of the bone marrow (BM), the ability to prevent central nervous system (CNS) relapse has further extended clinical success. However, extramedullary disease

Testicular and paratesticular tumors and tumor-like lesions in the first 2 decades

“…On microscopic examination there is usually a well-defined intertubular infiltrate of cells having the characteristic blastic morphology of ALL with lightly staining chromatin, ill-defined cytoplasm, and typically inconspicuous nucleoli. 189 Among 107 patients with ALL in clinical remission who had bilateral testicular biopsies, eight (7.5%) had occult leukemic infiltrates. 187 The three patients who did not receive additional treatment progressed with clinically evident relapse.…”

Testicular infiltrates in children with acute lymphoblastic leukemia: A prospective study

“…In this sense, routine testicular biopsies performed at 2 years' remission may help to identify a group of patients with high risk of late relapse. The review of the reported studies [19,20,23,31] shows that the overall rate of subsequent marrow or CNS relapses for patients with positive biopsies was 50% (21 out of 42 patients), which was significantly higher than the 16% (38 out of 229) for patients with negative biopsies. Consequently, we think that the practice of routine testes biopsy, employing new techniques with cell markers [32], maintains its value in detecting residual disease, at least until more effective therapies show that incidence of occult infiltrates is irrelevant.…”

“…Incidence of early and occult ITR was higher in boys with initial WBC counts over 20 x 109/l. Therapy in ITR generally consisted of local radiotherapy (20)(21)(22)(23)(24)(25) Gy), a new induction treatment followed by 2-year maintenance treatment; in three patients with early ITR, orchidectomy was also performed and six were given a new CNS preventive treatment. Clinical course in the seven patients with early ITR was unfavourable in five, with subsequent hematological relapses and death; one had a long-term disease-free survival (80 + months) and the other was a recent case.…”

Isolated Testicular Relapse Five Years After Cessation of Chemotherapy for Acute Lymphoblastic Leukemia

“…2,3,8,12 About 10 per cent of these patients have occult leukemic infiltration to the testes. 2,3,12 This patient had isolated testicular relapse 5 years after completing chemotherapy for ALL. In two large series of children having chemotherapy discontinued after 2.5 years or more of continuous remission maintenance therapy, none of them had bone marrow or extramedullary relapse 4.5 years after completing therapy.…”