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Jesus LED, Dekermacher S, Resende GC, Justiniano RR. Testicular involvement in pediatric acute lymphocytic leukemia: what to do about it? Int Braz J Urol 2022; 48:981-987. [DOI: 10.1590/s1677-5538.ibju.2022.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 06/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Hospital Universitário Antônio Pedro, Brasil; Hospital federal dos Servidores do Estado, Brasil
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Giudice MG, Del Vento F, Wyns C. Male fertility preservation in DSD, XXY, pre-gonadotoxic treatments - Update, methods, ethical issues, current outcomes, future directions. Best Pract Res Clin Endocrinol Metab 2019; 33:101261. [PMID: 30718080 DOI: 10.1016/j.beem.2019.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This paper aims at reviewing the fertility preservation strategies that could be considered in several conditions at risk of spermatogonial depletion such as 46,XY disorders of sexual development, Klinefelter syndrome and after gonadotoxic treatment in males highlighting current knowledge on diseases and processes involved in infertility as well as future directions along with their specific ethical issues. While sperm cryopreservation after puberty is the only validated technique for fertility preservation, for prepubertal boys facing gonadotoxic therapies or at risk of testicular tissue degeneration where testicular sperm is not present, cryopreservation of spermatogonial cells may be an option to ensure future parenthood. Promising results with transplantation and in vitro maturation of spermatogonial cells were achieved in animals but so far none of the techniques was applied in humans.
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Affiliation(s)
- Maria Grazia Giudice
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium
| | - Federico Del Vento
- Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium
| | - Christine Wyns
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Avenue Mounier 52, 1200 Brussels, Belgium.
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Del Vento F, Vermeulen M, de Michele F, Giudice MG, Poels J, des Rieux A, Wyns C. Tissue Engineering to Improve Immature Testicular Tissue and Cell Transplantation Outcomes: One Step Closer to Fertility Restoration for Prepubertal Boys Exposed to Gonadotoxic Treatments. Int J Mol Sci 2018; 19:ijms19010286. [PMID: 29346308 PMCID: PMC5796232 DOI: 10.3390/ijms19010286] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/15/2022] Open
Abstract
Despite their important contribution to the cure of both oncological and benign diseases, gonadotoxic therapies present the risk of a severe impairment of fertility. Sperm cryopreservation is not an option to preserve prepubertal boys’ reproductive potential, as their seminiferous tubules only contain spermatogonial stem cells (as diploid precursors of spermatozoa). Cryobanking of human immature testicular tissue (ITT) prior to gonadotoxic therapies is an accepted practice. Evaluation of cryopreserved ITT using xenotransplantation in nude mice showed the survival of a limited proportion of spermatogonia and their ability to proliferate and initiate differentiation. However, complete spermatogenesis could not be achieved in the mouse model. Loss of germ cells after ITT grafting points to the need to optimize the transplantation technique. Tissue engineering, a new branch of science that aims at improving cellular environment using scaffolds and molecules administration, might be an approach for further progress. In this review, after summarizing the lessons learned from human prepubertal testicular germ cells or tissue xenotransplantation experiments, we will focus on the benefits that might be gathered using bioengineering techniques to enhance transplantation outcomes by optimizing early tissue graft revascularization, protecting cells from toxic insults linked to ischemic injury and exploring strategies to promote cellular differentiation.
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Affiliation(s)
- Federico Del Vento
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
| | - Maxime Vermeulen
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
| | - Francesca de Michele
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Maria Grazia Giudice
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Jonathan Poels
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Anne des Rieux
- Advanced Drug Delivery and Biomaterials Unit, Louvain Drug Research Institute, Université Catholique de Louvain, 1200 Brussels, Belgium;
| | - Christine Wyns
- Gynecology-Andrology Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200 Brussels, Belgium; (F.D.V.); (M.V.); (F.d.M.); (M.G.G.)
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
- Correspondence: ; Tel.: +32-2-764-95-01
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Update on fertility restoration from prepubertal spermatogonial stem cells: How far are we from clinical practice? Stem Cell Res 2017; 21:171-177. [DOI: 10.1016/j.scr.2017.01.009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 01/15/2023] Open
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Vermeulen M, Poels J, de Michele F, des Rieux A, Wyns C. Restoring Fertility with Cryopreserved Prepubertal Testicular Tissue: Perspectives with Hydrogel Encapsulation, Nanotechnology, and Bioengineered Scaffolds. Ann Biomed Eng 2017; 45:1770-1781. [PMID: 28070774 DOI: 10.1007/s10439-017-1789-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
New and improved oncological therapies are now able to cure more than 80% of cancer-affected children in Europe. However, such treatments are gonadotoxic and result in fertility issues, especially in boys who are not able to provide a sperm sample before starting chemo/radiotherapy because of their prepubertal state. For these boys, cryopreservation of immature testicular tissue (ITT) is the only available option, aiming to preserve spermatogonial stem cells (SSCs). Both slow-freezing and vitrification have been investigated to this end and are now applied in a clinical setting for SSC cryopreservation. Research now has to focus on methods that will allow fertility restoration. This review discusses different studies that have been conducted on ITT transplantation, including those using growth factor supplementation like free molecules, or tissue encapsulation with or without nanoparticles, as well as the possibility of developing a bioartificial testis that can be used for in vitro gamete production or in vivo transplantation.
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Affiliation(s)
- Maxime Vermeulen
- Gynecology-Andrology Research Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200, Brussels, Belgium
| | - Jonathan Poels
- Gynecology-Andrology Research Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200, Brussels, Belgium.,Department of Gynecology-Andrology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Francesca de Michele
- Gynecology-Andrology Research Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200, Brussels, Belgium.,Department of Gynecology-Andrology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | - Anne des Rieux
- Advanced Drug Delivery and Biomaterials Unit, Louvain Drug Research Institute, Université Catholique de Louvain, 1200, Brussels, Belgium.,Institute of Condensed Matter and Nanosciences, Université Catholique de Louvain, 1348, Louvain-la-Neuve, Belgium
| | - Christine Wyns
- Gynecology-Andrology Research Unit, Medical School, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, 1200, Brussels, Belgium. .,Department of Gynecology-Andrology, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Jahnukainen K, Mitchell RT, Stukenborg JB. Testicular function and fertility preservation after treatment for haematological cancer. Curr Opin Endocrinol Diabetes Obes 2015; 22:217-23. [PMID: 25871959 DOI: 10.1097/med.0000000000000156] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Treatment for high-risk or relapsed haematological malignancy with haematopoietic stem cell transplantation is known to cause infertility. Today, there are no established options for fertility preservation in pre-pubertal boys. This review aims to describe how therapy for haematological malignancy in childhood affects male fertility, and to summarize recent developments for fertility preservation in these patients. RECENT FINDINGS Eventual recovery of spermatogenesis is probable after chemotherapy-based conditioning for haematopoietic stem cell transplantation. However, conditioning with total body irradiation is associated with a very high risk of permanent infertility. For high-risk patients, auto-transplantation of cryopreserved testicular tissue or cells might represent an approach for fertility preservation; however, contamination of testis tissue with malignant cells may prevent their subsequent reintroduction into patients. Recent progress using in-vitro differentiation of germ cells combined with assisted reproductive techniques may, in the future, represent a suitable alternative to retransplantation. SUMMARY Particular care must be taken when assessing infertility risk in patients with haematological malignancy as reclassification to high risk may significantly increase the likelihood of treatment-related gonadotoxicity. Importantly, development of fertility preservation strategies in such high-risk patients must also take into account specific risks for haematological cancers including cancer cell contamination.
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Affiliation(s)
- Kirsi Jahnukainen
- aPediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden bDivision of Haematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland cMRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh dThe Edinburgh Royal Hospital for Sick Children, Edinburgh, UK *Kirsi Jahnukainen, Rod T. Mitchell, and Jan-Bernd Stukenborg contributed equally to the writing of this aticle
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Chakraborty S, Gang S, Sengupta M. Functional status of testicular macrophages in an immunopriviledged niche in cadmium intoxicated murine testes. Am J Reprod Immunol 2014; 72:14-21. [PMID: 24629031 DOI: 10.1111/aji.12224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 02/04/2014] [Indexed: 11/27/2022] Open
Abstract
PROBLEM The present study investigates the extent of immunomodulatory effects associated with semenological alterations in the testes, after exposure to cadmium (in vivo) in male Swiss albino mice. Despite residing in an immunopriviledged site, testicular macrophages have immunogenic functions. METHODS OF STUDY Experimental animals were divided into two groups: (i) control (isotonic saline) and (ii) treated (0.35 mg/kg b.w of cadmium chloride) intraperitoneally for 15 days. Murine testicular macrophages were isolated and the cell function studies such as morphological alteration and tumor-necrosis factor (TNF-α) release assay were performed. Among the semenological parameters, sperm count, sperm motility, sperm morphology and the testosterone levels in the epididymal semen samples from both groups were determined. RESULTS The present work shows that cadmium is responsible for a significant alteration, degenerative changes and reduced cell function in testicular macrophages probably by increasing oxidative damage. Such oxidative stress also causes a parallel dysfunction of the semenological parameters. CONCLUSION TNF-α which is probably unable to bind with the surface receptor in testicular macrophages as because of altered structural morphology with reduction of cell function, render the animals more prone to infection and ultimately causes subfertility.
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Trigg ME, Steinherz PG, Chappell R, Johnstone HS, Gaynon PS, Kersey JH, Cherlow JM, Grossman NJ, Sather HN, Hammond GD. Early testicular biopsy in males with acute lymphoblastic leukemia: lack of impact on subsequent event-free survival. J Pediatr Hematol Oncol 2000; 22:27-33. [PMID: 10695818 DOI: 10.1097/00043426-200001000-00005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Children with acute lymphoblastic leukemia (ALL) who had bulky disease (lymphomatous features) at diagnosis had the highest rate of testicular relapse (20%) of any ALL subgroup on previous Children's Cancer Group (CCG) studies in the late 1980s. To limit curative, but sterilizing, testicular irradiation to those with testicular disease, testicular biopsies were performed to detect occult testicular disease within the first 6 months of treatment. Testicular irradiation then was provided to those with occult disease to increase disease-free survival. Identification of those with occult disease was believed to be a factor that would influence ultimate survival in such patients in that era. PATIENTS AND METHODS One hundred ninety-nine patients had bilateral testicular wedge biopsies performed during the first maintenance therapy phase of the four different chemotherapy regimens. Patients with positive biopsy results were treated with testicular irradiation and continued on therapy. RESULTS Eleven of 199 biopsy results (5.5%) were judged positive. Patients with positive biopsy results given testicular radiation had a 45% subsequent adverse event rate, compared with 36% for those with a negative biopsy results (P = 0.4). The survival rates for the two groups were similar. The low rate of positive biopsy specimens resulted in discontinuation of the procedure before closure of the study. CONCLUSION Positive testicular biopsy results early in remission identified patients at a slightly higher risk of subsequent adverse events but did not influence survival. However, because negative biopsy results (94.5%) did not alter the prescribed treatment, the small number of positive biopsy results did not warrant undertaking the procedure in most male patients with ALL, and this procedure was abandoned.
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Affiliation(s)
- M E Trigg
- DuPont Hospital for Children, Wilmington, Delaware, USA
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9
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THE EFFECT OF HUMAN CHORIONIC GONADOTROPIN ON METHOTREXATE CONCENTRATION IN THE RAT TESTES. J Urol 1997. [DOI: 10.1097/00005392-199710000-00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Bettencourt MC, Morris ER, Spevak M, Costabile R. THE EFFECT OF HUMAN CHORIONIC GONADOTROPIN ON METHOTREXATE CONCENTRATION IN THE RAT TESTES. J Urol 1997. [DOI: 10.1016/s0022-5347(01)64283-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marie-Claude Bettencourt
- From the Urology Service, Department of Surgery, the Department of Clinical Investigation, and the Military Andrology Research Center, Walter Reed Army Medical Center, Washington DC 20306-5001
| | - Elena R. Morris
- From the Urology Service, Department of Surgery, the Department of Clinical Investigation, and the Military Andrology Research Center, Walter Reed Army Medical Center, Washington DC 20306-5001
| | - Marianne Spevak
- From the Urology Service, Department of Surgery, the Department of Clinical Investigation, and the Military Andrology Research Center, Walter Reed Army Medical Center, Washington DC 20306-5001
| | - Raymond Costabile
- From the Urology Service, Department of Surgery, the Department of Clinical Investigation, and the Military Andrology Research Center, Walter Reed Army Medical Center, Washington DC 20306-5001
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Gajjar A, Ribeiro RC, Mahmoud HH, Sandlund JT, Liu Q, Furman WL, Santana VM, Crist WM, Rivera GK, Pui CH. Overt testicular disease at diagnosis is associated with high risk features and a poor prognosis in patients with childhood acute lymphoblastic leukemia. Cancer 1996. [DOI: 10.1002/(sici)1097-0142(19961201)78:11<2437::aid-cncr23>3.0.co;2-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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GONADAL STROMAL TUMORS, GONADOBLASTOMAS, EPIDERMOID CYSTS, AND SECONDARY TUMORS OF THE TESTIS IN CHILDREN. Urol Clin North Am 1993. [DOI: 10.1016/s0094-0143(21)00458-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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Abstract
Testicular relapse (TR) in adult acute myelogenous leukemia (AML) is uncommon, occurring in only 1-2% of patients with bone marrow relapse. TR in the absence of systemic relapse has been reported previously in 2 adults and 12 children, of which 67% were monocytic variants of AML. This article presents the case of a 29-year-old man with AML that relapsed in his testicle without evidence of bone marrow relapse. This patient and the two previously mentioned adults experienced bone marrow relapse within 2 months and died within 7 months of their TR. TR in adult myelogenous leukemia should be considered a harbinger of systemic relapse and suggests a need for aggressive local and systemic therapy.
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Affiliation(s)
- D W Shaffer
- Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234-6200
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15
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Abstract
Five cases of relapsing acute lymphocytic leukemia (ALL) presenting as an ovarian tumor have been treated at this institution, representing the largest reported series. In a review of the literature we identified 18 additional cases of ovarian leukemic relapse. Together, these 23 patients form the basis for this report. Abdominal pain is the most common presenting symptom of ovarian leukemia. An abdominal mass is usually palpable, and at least four patients had hydronephrosis. Nine patients had documented bilateral ovarian involvement; however, bilateral disease was not a poor prognostic sign. Most ovarian relapses occurred more than 36 months after the original diagnosis of ALL, with these "late'h relapsers responding more favorably to treatment than "early" relapsers. Definitive statements can not be made from a retrospective review of 23 case reports; however, salpingooophorectomy had no obvious advantage over simple biopsy, and there was no obvious advantage to the routine use of radiation therapy. Most failures in treating ovarian leukemia occurred within 2 years. Most failures were systemic rather than local, illustrating the need for aggressive multiagent systemic chemotherapy. Survival after ovarian leukemic relapse is possible, with eight of the 23 patients alive and in complete continuous remission following the ovarian relapse (median follow-up since relapse, 42 months; range, 2 to 135+ months). With the use of more intensive chemotherapy in recent protocols, the frequency of ovarian leukemic relapses appears to be decreasing. At this institution, no child with ALL diagnosed in the 1980s has subsequently developed an ovarian relapse.
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Affiliation(s)
- R C Pais
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322
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16
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Miller DR, Miller LP. Acute lymphoblastic leukemia in children: an update of clinical, biological, and therapeutic aspects. Crit Rev Oncol Hematol 1990; 10:131-64. [PMID: 2193648 DOI: 10.1016/1040-8428(90)90004-c] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- D R Miller
- Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois
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Suc E, Robert A, Rubie H, Regnier C, Guitard J, Caveriviere P, al Saati T, Kuhlein E, Chittal S, Delsol G. Immunohistochemical detection of post-therapy residual testicular lymphoblasts in childhood acute lymphoblastic leukemia (ALL). Pediatr Hematol Oncol 1989; 6:121-35. [PMID: 2702066 DOI: 10.3109/08880018909034278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study was to evaluate the diagnostic value of immunohistochemistry with monoclonal antibodies (MoAbs) in detecting residual blast cells in testicular biopsies from children with acute lymphoblastic leukemia (ALL). In a prospective study of 26 patients, testicular biopsies were performed after completion of therapy, and the average follow-up after biopsies was 29 months. After immunostaining, seven patients with negative biopsies on routine histology showed scattered, strongly calla-positive cells as well as cells reacting with anti-B (CD22) MoAb. Among these seven patients with residual blast cells, four had relapsed either in testes (n = 1), bone marrow and testes (n = 1), or in the bone marrow (n = 2). In contrast, among the 15 patients without residual blast cells, all but 1 remained in complete remission. In four other cases no definite conclusion was possible after immunohistochemical study. Four testicular biopsies from patients with occult infiltration were used as positive controls. Negative controls consisted of testicular biopsies from children with testicular ectopia and postmortem testicular tissue specimens. Results suggest that the risk of relapse is significantly higher in patients with positive immunohistochemical findings indicating persistent residual blast cells. However, the predictive value of these findings requires confirmation on a larger number of cases to have therapeutic implications.
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Affiliation(s)
- E Suc
- Department of Pediatric Hematology, C.H.U. Purpan, Toulouse, France
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Ohyashiki JH, Ohyashiki K, Shimizu H, Miki M, Kimura N, Mori S, Fujisawa K, Akatsuka J, Toyama K. Testicular tumor as the first manifestation of B-lymphoid blastic crisis in a case of Ph-positive chronic myelogenous leukemia. Am J Hematol 1988; 29:164-7. [PMID: 3263797 DOI: 10.1002/ajh.2830290308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We report an 8-year-old boy with Ph-positive chronic myelogenous leukemia (CML) who showed a testicular tumor as the first manifestation of blastic crisis. Pathological examination of the excised testis revealed marked infiltration of immature cells, whereas bone marrow remained in the chronic phase. Immunohistochemical and molecular examinations disclosed the immature cells to have B-lymphocyte surface determinants and immunoglobulin JH rearrangement. DNA obtained from the testis and peripheral blood cells showed similarly rearranged bcr configurations, indicating that infiltrating cells in the testis originated from the CML clone. Bone marrow showed B-lymphoid blastic crisis 4 months after testicular involvement.
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Affiliation(s)
- J H Ohyashiki
- Department of Internal Medicine, Tokyo Medical College, Japan
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Chan KW, Wood BJ, Johnson HW. Testicular adhesion: a potential complication from wedge testicular biopsy in childhood leukemia. MEDICAL AND PEDIATRIC ONCOLOGY 1988; 16:366-7. [PMID: 3185366 DOI: 10.1002/mpo.2950160516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Elective bilateral wedge testicular biopsy is frequently performed in childhood acute lymphoblastic leukemia. Acute and delayed complications of this procedure are rarely encountered. We report on two children with testicular adhesions 16 and 20 months postsurgery. In each instance there were resultant diagnostic and management difficulties. The possible cause and potential side effects of testicular adhesions are discussed.
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Affiliation(s)
- K W Chan
- Department of Paediatrics, B.C.'s Children's Hospital, Vancouver, Canada
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20
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Russo A, Schiliro' G. The enigma of testicular leukemia: a critical review. MEDICAL AND PEDIATRIC ONCOLOGY 1986; 14:300-5. [PMID: 3537653 DOI: 10.1002/mpo.2950140603] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Isolated testicular relapse (T.R.) in acute lymphoblastic leukemia (ALL) has an overall incidence of 10% and affects mainly patients off therapy. Multivariate analysis of pretreatment characteristics has shown that lymphadenopathy and splenomegaly are independently associated with increased risk of T.R. during maintenance and off therapy, respectively. Sequential biopsy studies have demonstrated that testicular biopsies are unable to detect scanty infiltrates and have no practical utility. Prophylactic gonadal irradiation produced equivocal results and should not be used because of its sterilizing effect. Intensive multi-drug regimens or prolonged maintenance were unable to substantially reduce T.R. rate. On the contrary, intermediate-dose methotrexate (IDM) early in remission has almost abolished T.R. These findings strongly support the hypothesis that testicular interstitium is a very peculiar site where blasts are partially protected from the drug action; high drug concentrations are required for the optimal cytocidal effect. There are sufficient clues of a link between the excess of late marrow relapse in male sex and the capacity of testes of harboring blasts. Therefore IDM early in remission should be routinely adopted for prevention of testicular leukemia and its potential of late spread.
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