Testicular myeloid sarcoma: case report
The present study describes a 38-year-old man with an initial history of an enlarged left testicle that lasted for five months, followed by inguinal adenopathy, weight loss and abdominal distention. The investigation at the clinic where the case was first seen included a biopsy of an inguinal lymph node, which detected infiltration by undifferentiated malignant neoplasia that was compatible with infiltration by myeloblasts, seen through immunohistochemical analysis. The patient initially refused specific treatment for five months, but there was progressive enlargement of the left testicle and inguinal lymph nodes, with progressive clinical deterioration. For this reason, the patient was referred to Hospital de Clínicas, Universidade Federal do Triângulo Mineiro, where he was admitted presenting acute postrenal kidney failure due to extrinsic compression of the urinary tract, which required emergency hemodialysis and percutaneous nephrostomy.\nThe complete blood count showed leukocytosis (14.8 x 109/L), with the presence of blastic cells in peripheral blood, without anemia or thrombocytopenia. A bone marrow aspirate showed that 26% of the nucleated cells were blasts that, from flow cytometry, were defined as presenting an immunophenotype compatible with a myeloid origin (CD45+, CD13+, CD33+,HLADR+ and CD11c+).\nAn ultrasound scan demonstrated that some abdominal structures were extensively compromised (mesentery, parietal peritoneum, right colon and bilateral obstructive hydronephrosis due to extrinsic compression of the ureters). The left testicle was enlarged (volume of 76 mL) due to an infiltrative process, with enlargement of the epididymis and spermatic cord structures and thickening of the skin and subcutaneous tissue. Computed tomography of theabdomen showed that the left diaphragm, ileocecal junction and periaortic-pericaval lymph node cluster were compromised, with severe ascites and moderate bilateral pleural effusion.\nAnatomopathological and immunohistochemical analyses of a sample from a left orchiectomy ( & ) revealed the presence of diffuse infiltration of the testicle, epididymis and spermatic cord structures by a hematopoietic neoplasia compatible with myeloid sarcoma [CD117+, CD34+, CD68+,myeloperoxidase (MPO)+, CD3-and CD20-]. No cytogeneticanalysis was performed.\nChemotherapy (cytarabine and hydroxyurea) was startedin association with extensive abdominal radiotherapy, but the patient's condition evolved with progressive organ dysfunction that culminated in death seven days later due to disease progression.