Primary Testicular Lymphoma: A Case Report and Review of the Literature

Background and Aim: Primary testicular lymphoma (PTL) is a rare form of extranodal non-Hodgkin’s lymphoma. It represents for 1% - 2% of non-Hodgkin’s lymphoma, and mostly affects the elderly. We describe an interesting case of PTL managed by a combined multimodal approach with a review of the literature. Case Presentation: Patient aged 56 years, consulted for an increase in the volume of the right testicle without associated pain, all evolving in the context of a slight decline in general condition. Clinical examination revealed a large painless mass in the right scrotal bursa. A scrotal ultrasound showed a right intra-testicular mass. The patient had undergone inguinal orchiectomy. Pathological analysis showed diffuse large B-cell lymphoma of the testis. Whole-body 18-fluorodeoxyglucose positron emission tomography (18-FDG-PET-CT) showed no suspicious hypermetabolism. Lumbar puncture did not reveal malignant cells in the cerebrospinal fluid (CSF). The patient then received 6 cycles of chemotherapy according to the R-CHOP protocol (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) and 2 cycles of intrathecal methotrexate. After chemotherapy, scrotal radiotherapy at a dose of 30 Gy was delivered. The evolution was marked by the death of the patient six months after the end of the scrotal radiotherapy following a diffuse lymph node relapse with a profound alteration of the general state. Conclusion: The treatment depends imperatively on the stage of the disease. The therapeutic approach is multimodal and combined based on orchiectomy, systemic and intrathecal treatment and scrotal radiotherapy. PTL is an aggressive malignant with a poor prognosis. Randomized trials are needed to define a better therapeutic strategy.

Primary testicular lymphoma:Clinical characteristics and oncological outcomes

Background:Primary testicular lymphoma(PTL)is a rare testicular malignancy,despite being considered the most common testicular tumorin patients olderthan 60 years.Primary testicularlymphoma represents only 1%-9%oftesticular neoplasms.Few studies have been published regarding its clinical features and management.This study aimed to analyze the clinical characteristics and outcomes of PTL.Materials and methods:Orchiectomy specimens of 15 patients with PTL diagnosed during 2000-2020 at our institution were retrospectively studied.We collected information on demographic data,clinical features,management aspects,and outcomes of PTL treatment.Kaplan-Meier survival curves and Cox regression analyses were used to study survival.Results:The median patient age was 69 years(interquartile range,61-72 years).The most prevalent clinical presentation was testicular swelling(80%),and only 13.33%of the patients presented with systemic symptoms.Centralnervous system involvement was detected in 6 patients(40%).Of the 15 patients,5(33.33%)had stage IE and 10(66.67%)had stage IVE lymphoma.Diffuse large B-cell lymphoma was the most common histological subtype.Twelve patients(80%)received chemotherapy.During follow-up,4 patients(26.67%)relapsed.The recurrence ratein the contralateraltesticle was 13.33%.The median cancer-specific survivalwas 21.58 months(95%confidence interval,0-43.95 months).Univariate Cox regression analysis showed that central nervous system involvement and International Prognostic Index score were significantly associated with shorter cancer-specific survival.Conclusions:Primary testicularlymphoma has a high relapse rate and poor prognosis.Management strategies typicallyinclude radical orchiectomy and systemic chemotherapy.Central nervous system involvement and International Prognostic Index scores were associated with lymphoma-specific survival.