Overt testicular disease at diagnosis in childhood acute lymphoblastic leukemia: prognostic significance and role of testicular irradiation

Abstract

Objective. To analyze the prognostic impact of overt testicular disease (OTD) at diagnosis and role of testicular irradiation in the same.Methods. Data of 579 boys treated at our center over 16 years was reviewed.Results. Fourteen (2.4%) males had OTD. 10 (71.4%) of these had high-risk disease. Patients with OTD, had a significantly higher incidence of mediastinal-adenopathy (p=0.001), hyperleucocytosis (p=0.004) and CNS disease at presentation (p<0.0001) compared to patients in continuous complete remission (CCR). 4 of the 11 patients with OTD, who opted for therapy, had relapse; 2 are in CCR. Although, survival in patients with OTD was inferior (p=0.183) compared to patients without OTD, it was not an independent prognostic factor (p=0.47). In the entire study cohort, symptom-diagnosis interval (p=0.006), white cell (p=0.001) and platelet count (p=0.001) at presentation were significantly associated with survival (Cox multivariate regression analysis). Conclusions. OTD was not an independent prognostic factor, despite association with high-risk features. Survival outcome was inferior. The observations indicate the need of revaluation of the present protocol with incorporation of intermediate dose and subsequently high-dose methotrexate (after assessment for toxicity and tolerance), risk-stratified therapy and plausibly omission of testicular irradiation. [Indian J Pediatr 2010; 77 (7) : 779-783]

Clinical characteristics and treatment outcome of childhood acute lymphoblastic leukemia in Saudi Arabia: A multi‐institutional retrospective national collaborative study

“…Over 5% of the patients were documented as having CNS3 disease, which is higher than the 2-3% that has been reported in various studies [37][38][39]. Similarly, the incidence of overt testicular involvement in boys, at 3.6%, is also higher than what is reported in the literature [40][41][42]. The reason for this higher proportion of patients with extramedullary disease is unclear and may be a consequence of misdiagnosis or of delays in diagnosis.…”

Cytopathological Diagnosis of an Unusual Cause of Malignant Hydrocele

“… 5 However, OTD at initial diagnosis is rare (1.1%–2.4%). 6 Clinical, radiological (USG and MRI), and pathological (testicular biopsy) tools are available to diagnose testicular ALL. Importantly, testicular involvement may be occult, and microscopic infiltration has been demonstrated by bilateral wedge biopsies in 10%–33% patients at some time during first 3 years of therapy, 21% at the initial presentation and 64%–92% at autopsy.…”