Surgical Aspects of Patients With Leukemic Testicular Infiltration

Leukemia is the most common childhood cancer, accounting for one-third of malignancies in this age group. Testicular infiltration in pediatric leukemia patients represents a manifestation of leukemic dissemination beyond the bone marrow and can occur at diagnosis or be a sign of relapse. Testicular infiltration may occur particularly in specific leukemia subtypes, such as acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma (LBL) and is an important prognostic factor, as it may indicate an increased risk of leukemia relapse. Therefore, rigorous follow-up is essential to detect testicular infiltration early and initiate appropriate treatment. This study aims to evaluate cases of leukemia with testicular infiltration in two pediatric oncology referral centers in two different countries. We conducted a retrospective study of patients presenting with secondary testicular infiltration due to leukemia over a 14-year period (January 2010 to December 2023). During the study period, we identified 24 patients who developed testicular infiltration secondary to leukemia. All cases of testicular infiltration were diagnosed at the time of disease relapse. Fourteen patients presented with isolated testicular relapse, while the remaining patients had additional relapse sites in combination with testicular recurrence: bone marrow (10 cases) and central nervous system (2 cases). The mean age at diagnosis was 7.91 years. The average leukocyte count at diagnosis was 56 211/mm³, with only five patients presenting with leukocyte counts above 100 000/mm³. Four children (16.6%) were diagnosed with T-cell ALL, 20 (83.4%) with B-cell ALL. Fifteen patients (62.5%) underwent hematopoietic stem cell transplantation, including two haploidentical transplants. Twelve patients (50%) died-three due to disease progression and one from disseminated fusariosis. Data regarding the cause of death were unavailable for the remaining patients. The average follow-up duration was 5.87 years, with an event-free survival of 2.085 years. Although rare, testicular infiltration in leukemia patients is a clinically significant phenomenon that may affect both prognosis and quality of life. Early diagnosis and appropriate treatment of the underlying leukemia are crucial to improve outcomes. Monitoring of testicular function and fertility-related concerns must also be addressed comprehensively in patient management. Future studies with larger cohorts and standardized management protocols are essential to establish clear guidelines for the diagnosis, treatment, and follow-up of patients with testicular relapse secondary to ALL. Given the low number of cases and the diversity of local resources worldwide (especially regarding radiotherapy and endocrine follow up), the best approach for each patient should be determined in multidisciplinary team discussions.