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Henoch-Schonlein purpura (HSP) with involvement of the testes is extremely rare. Here, we present a pediatric case of HSP involving testicular ischemic necrosis in an 8-year-old child. Ultrasonography plays an important role not only in the differential diagnosis at onset, but also in the assessment of treatment response and prognosis during treatment and at follow-up. In this case report, we present the sonographic images for the entire course of testicular involvement in HSP and reveal histopathologically the pathogeny as testicular autoimmune vasculitis caused by the deposition of immunoglobulin A-containing immune complexes in the testicular vessels.

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma in children. The tumor spreads by local extension, to regional lymph nodes, or by distant metastasis. Only few cases of intratesticular metastatic RMS have been reported in the published data. We present a case of an 18-year-old boy with metastatic alveolar RMS to the testis and the first reported case of bilateral testicular involvement.

We present an immunocompromised patient with a painless testicular mass. Usually, this mass is suspicious for testicular cancer; however, a fungal abscess from Pseudallescheria boydii was found. The patient eventually died from disseminating infection. This is the first such report of a testicular infection involving P. boydii. Early diagnosis and treatment are paramount because of the poor outcome with disseminated disease.

Testicular involvement in acute lymphocytic leukemia is considered an indicator of extramedullary relapse following chemotherapy. Biopsy of the testes prior to the cessation of chemotherapy has yielded early diagnosis and treatment of relapse, with an improved prognosis. Scrotal ultrasonography successfully guided the biopsy of palpably normal testes in a boy with acute lymphocytic leukemia. This success suggests that ultrasound may be a useful adjunct in localizing occult testicular leukemia prior to biopsy.

Contemporary therapy of acute leukemia frequently achieves long-term continued complete remission (CCR) of bone marrow disease and prevents central nervous system relapse. However, accompanying improved survival is an increasing incidence of overt testicular relapse either during CCR or associated with bone marrow relapse. In 7 boys testicular abnormalities developed during CCR, 6 had open biopsy and 5 had histologically confirmed leukemic infiltration. Despite local therapy of orchiectomy or irradiation and chemotherapy reinduction, 2 of 6 had testicular relapse and 4 of 6 died. Three boys with coexistent overt testicular and systemic relapse died. Nine boys with normal testes had testicular biopsy during CCR prior to discontinuation of chemotherapy. Results of all biopsies were benign, but one boy had a relapse. The diagnosis of occult testicular leukemia prior to discontinuation of chemotherapy allows selection of high-risk boys requiring prolonged, intensive, and possibly alternative therapy. The indication for testicular biopsy in boys with acute leukemia is documented, and appropriate clinical management of testicular leukemia is presented.

Malignant lymphoma is reviewed briefly. Recent literature emphasizes the rarity, bilateral tendency, and poor prognosis of primary testicular involvement. Lymphoma, however, is the most frequent metastatic tumor in this location. A case is reported of a patient living and well ten years after orchiectomy for reticulum cell sarcoma.

A case is presented of a sixty-three-year-old man with multiple myeloma which progressedto plasma-cell leukemia.

Testicular biopsy has become a routine procedure before discontinuing chemotherapy in male children being treated for acute lymphocytic leukemia (ALL). Before a decision can be made to discontinue multiple drug therapy, all possible sites of occult tumor such as the testis, cerebrospinal fluid, and bone marrow must be sampled. Between December 1978 and November 1981, 25 male children underwent testicular biopsies after two or more years of combination chemotherapy at the Babies Hospital, Columbia-Presbyterian Medical Center. Only 3 of the 25 patients (12%) were found to have leukemic infiltrates on histologic sections. Two of 3 patients, however, were noted preoperatively to have either irregular testicular contours or testicular enlargement and induration. Occult testicular infiltration discovered after two or more years of chemotherapy is rare. Most children with a histologically positive biopsy result were at least suspected preoperatively to have testicular involvement.

Two patients with Henoch-Schonlein syndrome presented with clinical pictures mimicking testicular torsion. No evidence of testicular torsion was found. A review of the literature revealed that testis torsion is very rarely associated with testicular involvement in Henoch-Schonlein syndrome, and hence only rarely is surgical exploration required.