{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:13:14Z","timestamp":1792181594838,"version":"4.4.0"},"reference-count":52,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Acute lymphoblastic leukemia (ALL) is a malignant condition of lymphoid progenitor cells that primarily affects the pediatric population, but also adults. The 5-year survival rate is 90% in children and approximately 40% in adults, with survival increasing through the use of peripheral stem cell allotransplantation (SCT). The relapse rate after stem cell transplantation (SCT) in adult acute lymphoblastic leukemia (ALL) patients ranges from 35% to 45%, making relapse a major cause of death in this population. Background: We present an atypical case of late testicular involvement in ALL in a 50-year-old man diagnosed with ALL pro-T in remission post-chemotherapy (GMALL 2003 protocol) and allogeneic stem cell transplantation (alloSCT) from a related donor. Methods: This case describes a 50-year-old male with ALL pro-T who experienced three rare extramedullary relapses post-chemotherapy and alloSCT. Five years after remission, he had a unilateral testicular relapse confirmed by immunophenotyping of spermatic fluid. Results: Despite no bone marrow involvement, he was treated with chemotherapy, intrathecal therapy, and bilateral testicular radiotherapy. He later relapsed in the orbit, controlled by radiotherapy, followed by a third relapse in the heart and colon. Conclusions: This case highlights the unusual sites and consecutive nature of extramedullary relapses in adult ALL.<\/jats:p>","DOI":"10.3390\/jcm14020405","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T03:48:11Z","timestamp":1736480891000},"page":"405","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Unique Case of Extramedullary Relapse in Acute Lymphoblastic Leukemia: Testicular to Ocular, Cardiac, and Colonic Involvement and the Role of Sperm Phenotyping in Diagnosis\u2014Case Report and Literature Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-2806-2688","authenticated-orcid":false,"given":"Alina Camelia","family":"C\u0103tan\u0103","sequence":"first","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"},{"name":"Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4392-8522","authenticated-orcid":false,"given":"Maria-Gabriela","family":"Vl\u0103doiu","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"},{"name":"Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Sandu","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariela","family":"Olteanu","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Mocanu","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Mihai","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1121-3788","authenticated-orcid":false,"given":"Minodora","family":"Teodoru","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"},{"name":"Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudiu","family":"Matei","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"},{"name":"Medlife Polisano Hospital, 550172 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Zahu","sequence":"additional","affiliation":[{"name":"Amethyst Radiotherapy Center, 407280 Cluj Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zsofia","family":"Varady","sequence":"additional","affiliation":[{"name":"Fundeni Clinical Insitute, 022328 Bucuresti, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Mondoc","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"},{"name":"Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Noor","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"},{"name":"Faculty of Medicine Sibiu, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Moicean","sequence":"additional","affiliation":[{"name":"S\u00f6dersjukhus Hospital, 11883 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geanina","family":"Mera","sequence":"additional","affiliation":[{"name":"County Clinical Emergency Hospital Sibiu, 550245 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Wang, L., Ashraf, D.C., Kinde, B., Ohgami, R.S., Kumar, J., and Kersten, R.C. 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