Neoplasias hematológicas con implicación testicular

espanolOBJETIVO: Presentamos dos casos de pacientes diagnosticados de tumor hematologico que presentan recidiva a nivel testicular, realizamos la revision de la literatura en relacion a lo infrecuente de dicha patologia. METODOS: Revision retrospectiva de la historia clinica de dos pacientes diagnosticados de neoplasias hematologicas (Leucemia Mieloblastica Aguda y Mieloma multiple) con aparicion de recidiva a nivel testicular. Revisamos el manejo y resultado tras tratamiento mediante orquiectomia bilateral. RESULTADO: Caso 1: Paciente diagnosticado de Leucemia mieloblastica aguda tratada mediante trasplante alogenico. Dos anos despues el paciente refiere aumento del tamano testicular. En estudios complementarios se sospecha recidiva a nivel testicular que tras orquiectomia se confirma. Actualmente se encuentra a la espera de tratamiento quimioterapico previo a nuevo trasplante alogenico. Caso 2: Paciente diagnosticado de Mieloma Multiple que inicia tratamiento poliquimioterapico sin respuesta, se realiza trasplante alogenico. Tras cinco meses de remision completa se evidencian signos de recidiva sistemica realizandose estudio para nuevo trasplante. Durante el mismo se objetiva posible recidiva a nivel testicular. Tras pruebas complementarias se realiza orquiectomia bilateral y se confirma el diagnostico. Actualmente el paciente se encuentra en protocolo de trasplante alogenico tras tratamiento radio y quimioterapico. CONCLUSIONES: Actualmente el porcentaje de mortalidad, en los casos de recidiva a nivel testicular secundaria a neoplasia hematologica, ha disminuido pese al marcado aumento de su incidencia. Esto se debe, como en nuestros casos, a un diagnostico precoz y al uso combinado de quimioterapia, radioterapia y cirugia. Esto se logra a traves de un trabajo interdisciplinario entre urologos, hematologos, oncologos y radioterapeutas. EnglishOBJECTIVE: We report two cases of patients with a previous diagnosis of hematologic tumor who present with testicular recurrence, and we carry out a review of the literature regarding the infrequency of this pathology. METHODS: We present a retrospective review of the medical records of two patients diagnosed with hematologic malignancies (acute myelogenous leukemia and multiple myeloma) with occurrence of relapse in the testicle. We reviewed the management and outcome after treatment with bilateral orchiectomy. RESULTS: Case 1: The patient was diagnosed with acute myeloid leukemia and treated with an allogeneic transplant. Two years later, the patient reported an increase in testicular size. The complementary studies lead us to suspect a testicular recurrence that was confirmed after orchiectomy. Currently, the patient awaits the start of a chemotherapy treatment prior to a new allogeneic transplant. Case 2: Patient with the diagnosis of multiple myeloma who started a polychemotherapy treatment without response and underwent allogeneic transplant. After five months with complete remission, there were signs of systemic recurrence, and a study for a new transplant was carried out. During the study, potential testicular recurrence was observed. After a batch of complementary tests, bilateral orchiectomy was performed and the diagnosis was confirmed. Currently, the patient is undergoing an allogeneic transplant protocol after radiotherapy and chemotherapy treatment. CONCLUSIONS: Currently the mortality rate in cases of relapse of hematologic malignancy in the testicle has declined despite the sharp rise in its incidence. This is because of, as in our case, early diagnosis and the combined use of chemotherapy, radiotherapy and surgery. This has been achieved through an interdisciplinary collaboration of urologists, hematologists, oncologists and radiotherapists.