Testicular
localization of
multiple myeloma: case report
Mbarek
Doublali, Abdelhak Khallouk, Fadl
Tazi,
Mohammed Jamal El Fassi, Moulay Hassan Farih.
Department
of Urology, University Hospital Center Hassan II, Fez
–Morocco
Corresponding
author: Mbarek
Doublali,
Service
d’urologie,
CHU Hassan II Fès,
Morocco. Tel :
(+212) 661 555 340. Email: adamdoublali@yahoo.fr
Afr J
Haematol Oncol 2010;1(1):21-23
SUMMARY
Testicular
localisation of myeloma is exceptional. We report the case of a patient managed
for multiple myeloma for a period of
9 months. He then presented with testicular localisation of his
disease for which an inguinal orchidectomy
was carried out. Despite the orchidectomy, disease progression was rapid with
severe bone pain and terminal kidney
failure three months later. The diagnosis and the course of action are
discussed in light of the current literature.
Key words:
Multiple myeloma; testis; metastasis
INTRODUCTION
Patients
with multiple myeloma generally come forward at an advanced stage of
the
disease with multiple osteolytic lesions as well as diffuse
extramedullary
lesions. The testis and epididymis are rarely involved , particularly as solitary
extramedullary sites. In almost all
reported cases of multiple myeloma with testicular localisation, the
patients
had already had other disseminated lesions.
We report a rare case of
multiple myeloma with
testicular secondary localisation.
CASE REPORT
Mr J.M.
aged 54 was hospitalised 9 months after diagnosis of multiple myeloma
to
receive VAD (Vincristine, Adriamycin and Dexamethasone) chemotherapy. During
his stay at the hospital, the
patient
developed sharp testicular
pain
without trauma
or urinary symptoms . The
left testis was swollen and tender on examination. Ultrasonography
examination showed a normal right testicle and a left
testicle which was increased in size
with
heterogeneous hypoechogenic
areas ,
the biggest of which measured 2 cm. These areas were
hypervascularized
in Dopper mode.
Alpha-foetoprotein, beta-hCG and
lactate dehydrogenase (LDH)
were normal.
The patient underwent a left inguinal orchidectomy. The
anatomicopathological
study showed
the presence of monoclonal
plasma cells
confined to the left
testicle (figure
1). Three months later, the
patient
did not present any other extramedullary localisations but the progress
of the
disease was rapid with increased bone pain and terminal kidney failure
.
|
Figure 1. Plasma cell proliferation involving testicular parenchyma (A). Plasmocytoid cells (B). Tumor cells intensively marked by the anti-CD138 antibody on immunohistochemistry (C). |
DISCUSSION
Advanced
extramedullary multiple myeloma is not a rare occurrence . In autopsy
studies
65 to 71% of patients have extramedullary localisation 1-2.
Nevertheless
the testis is a rare site of localisation for multiple myeloma. We
found only
39 cases of testicular or epididymal plasmacytoma published in the
English
literature.
Hayes et al found one case
of testicular localisation of multiple myeloma in 38 cases at autopsy.
They
also reviewed 182 cases of extramedullary multiple myeloma and found 5
cases of
testicular localisation 3.
Gordon
et al reported two cases 4,
whereas Pasmentier et al reported no
case in their series of 57 autopsies 5. Levin
et
al reviewed 6000 cases of
testicular tumors
at the Armed Forces Pathology Institute and they found only seven cases
of
myeloma (approximatively 0.1%) which clearly shows that myeloma is a
rare cause
of testicular mass 6. The
diagnosis of myeloma testicular localisation is histological. In the
case of
solitary testicular plasmocytoma, the treatment is based on only
orchidectomy
with no risk of recurrence in the short
term 7-8. For
the case
where the testicular localisation is an element of the diffuse disease,
combined standard chemotherapy for multiple myeloma and radiotherapy is
currently the main treatment strategy. However, with this approach, the
prognosis is generally poor as per a review of 34 such cases by Anghel
et al 9.
Unlike other cases of testicular plasmacytoma reported in the
literature, our
case did not present with any other extramedullary involvement except
for the
testicular localisation but still the disease progressed rapidly
despite
orchidectomy and chemotherapy. Bortezomib-based combination
chemotherapy, where
available, might produce a rapid response in these patients 10. In
the case where the patient presents at an
advanced stage with intense pain as was our case, radiotherapy is a
good
palliative option which can secure local control.
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