SHM Converge Scientific Abstract ePoster Gallery-Occam's Razor: Cutting Through the Complexity of a Testicular Mass in a Young Patient With History of Acute Lymphoblastic Leukemia (All)

Occam's Razor: Cutting Through the Complexity of a Testicular Mass in a Young Patient With History of Acute Lymphoblastic Leukemia (All)

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This case describes a 26-year-old man with a history of T-cell acute lymphoblastic leukemia (T-ALL) with CNS involvement, in remission after hyperCVAD and maintenance POMP therapy, who developed a new painful, firm right testicular mass. Because the testes can be a sanctuary site for leukemia relapse, the initial concern was recurrent ALL. Workup showed a 4-cm hypervascular testicular mass on ultrasound, localized uptake on PET scan, and normal or low tumor markers (AFP, LDH, hCG). Bone marrow biopsy and lumbar puncture were negative, arguing against leukemic relapse.  <br /><br />The patient underwent radical orchiectomy, and pathology unexpectedly revealed a T1b seminoma with negative margins. He was then planned for active surveillance for stage I testicular cancer while continuing maintenance treatment for T-ALL.  <br /><br />The report emphasizes that in young men—especially those with cancer histories—a testicular mass should prompt evaluation for both recurrence and a new primary malignancy. Although testicular relapse can occur in ALL, isolated testicular relapse in T-ALL is rare. In contrast, testicular cancer is the most common solid tumor in males ages 15 to 35. Negative tumor markers do not exclude seminoma. Initial evaluation should include testicular ultrasound and serum markers, and when malignancy is suspected, radical orchiectomy is preferred; biopsy is avoided because of tumor seeding risk. Early-stage seminoma has excellent prognosis, with very high cure rates and surveillance often recommended after orchiectomy.

Asset Subtitle

Ali Farkhondehpour

Meta Tag

Author List Ahmed Shabaik, Ali Farkhondehpour, Divya Koura, Kaitlyn Dykes, Lobna Shahatto

Category Clinical Vignettes

Concept Testicular Mass

Concept Testicular Malignancy

Concept Radical Orchiectomy

Concept Acute Lymphoblastic Leukemia

Concept Leukemia Relapse

Distinguished Non-Finalist

Presenter Organization University of California San Diego

Presenting Author Ali Farkhondehpour

Track Adult

Keywords

T-cell acute lymphoblastic leukemia

testicular mass

seminoma

orchiectomy

CNS involvement

testicular relapse

hypervascular ultrasound

PET scan

tumor markers

active surveillance

Testicular Mass

Testicular Malignancy

Radical Orchiectomy

Acute Lymphoblastic Leukemia

Leukemia Relapse