Isolated testicular recurrence of B cell acute lymphoblastic leukaemia in an adult: rare case

What is it about?

80 years old male who was previously diagnosed with Philadelphia positive B cell-Acute Lymphoblastic Leukemia (ALL) in remission post-allogeneic matched unrelated donor peripheral blood stem cell transplant (allo-PBSCT). Five years later, he was found to have unilateral testicular relapse of Philadelphia + B-cell ALL proven by pathology after radical orchiectomy. Bone marrow aspirate and biopsy did not show evidence of leukemia. Patient was treated with adjuvant radiation therapy and started on Dasatinib 50 mg daily. Given his age and absence of disseminated ALL, no adjuvant chemotherapy was utilized. He is monitored with monthly Polymerase Chain Reaction studies (PCRs). At one year follow-up, no findings suggestive of recurrence of ALL have been identified and the patient is maintained on the Dasatinib. Although isolated testicular recurrence is common among pediatric population, it is a rare event among adults as it is considered an immunological sanctuary for cancer cells.

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