Testicular lymphoma
Citation, DOI, disclosures and article data
At the time the article was created Henry Knipe had no recorded disclosures.
View Henry Knipe's current disclosuresAt the time the article was last revised Mohammad Taghi Niknejad had no financial relationships to ineligible companies to disclose.
View Mohammad Taghi Niknejad's current disclosures- Primary testicular lymphoma
- Scrotal lymphoma
- Lymphoma of testis
- Lymphoma involving testis
Testicular lymphoma is an uncommon testicular malignancy. Lymphoma can involve the testes in three ways:
primary site of extranodal disease (primary testicular lymphoma)
secondary involvement of systemic disease
primary manifestation of subclinical systemic disease
This article is concerned with primary testicular lymphoma.
On this page:
Epidemiology
Testicular lymphoma accounts for ~10% of testicular malignancies and ~2% of non-Hodgkin lymphomas 1. It is the most common bilateral intratesticular tumor.
It is the most common testicular tumor in men over the age of 60 years 3.
Clinical presentation
Unilateral testicular swelling or mass is the most common presentation, although the bilateral presentation is common (40%) 1,3.
Systemic symptoms such as weight loss, fever, and weakness may be present.
Pathology
Diffuse large B-cell lymphoma (DLBCL) accounts for the majority (~80%) of cases. Extranodal involvement is common, especially 3,4:
skin and subcutaneous tissues
central nervous system
contralateral testis
lung
Microscopy
Large sheets of lymphoid cells infiltrate the testicular tissue. In early-onset lymphomas, malignant lymphoid cells invade the areas between the seminiferous tubules. As the illness progresses, these cells further invade the seminiferous tubules and replace the normal parenchyma. The tumor cells primarily exhibit centroblastic morphology, with immunoblastic morphology occurring less commonly.
Positive IHC markers are CD19, CD20, CD79a, PAX5, BCL6, MUM1 and BCL2. Negative IHC markers are CD30, SALL4, CyclinD1, and Pan T cell antigen 7,8.
Radiographic features
Ultrasound
Ultrasound features are non-specific 4:
diffuse enlargement with ill-defined hypoechoic signal
discrete hypoechoic intratesticular mass(es)
epididymis may be enlarged and hypoechoic as well
color Doppler: testis is markedly hypervascular
Treatment and prognosis
Orchiectomy and systemic chemotherapy are preferred treatments due to distant sites of relapses. The 10-year survival is reported at 88% with a relapse rate of 8% 5,6.
Differential diagnosis
For ultrasound appearances, consider 4:
epidydimo-orchitis and orchitis (overlapping ultrasound features, distinction often clinical)
testicular leukemia (similar ultrasound appearance)
testicular metastases (rare)
References
- 1. Ahmad S, Idris S, Follows G, Williams M. Primary Testicular Lymphoma. Clin Oncol (R Coll Radiol). 2012;24(5):358-65. doi:10.1016/j.clon.2012.02.005 - Pubmed
- 2. Cheah C, Wirth A, Seymour J. Primary Testicular Lymphoma. Blood. 2014;123(4):486-93. doi:10.1182/blood-2013-10-530659 - Pubmed
- 3. Sommers D & Winter T. Ultrasonography Evaluation of Scrotal Masses. Radiol Clin North Am. 2014;52(6):1265-81. doi:10.1016/j.rcl.2014.07.014 - Pubmed
- 4. Goodman J, Carr L, Ostrovsky P, Sunshine R, Yeh H, Cohen E. Testicular Lymphoma: Sonographic Findings. Urol Radiol. 1985;7(1):25-7. doi:10.1007/bf02926844 - Pubmed
- 5. Vural F, Cagirgan S, Saydam G, Hekimgil M, Soyer N, Tombuloglu M. Primary Testicular Lymphoma. J Natl Med Assoc. 2007;99(11):1277-82. PMC2574328 - Pubmed
- 6. Lokesh K, Sathyanarayanan V, Kuntegowdanahalli C, Suresh T, Dasappa L, Kanakasetty G. Primary Diffuse Large B-Cell Lymphoma of Testis: A Single Centre Experience and Review of Literature. Urol Ann. 2014;6(3):231-4. doi:10.4103/0974-7796.134277 - Pubmed
- 7. Teri A. Longacre. Mills and Sternberg's Diagnostic Surgical Pathology. (2021) ISBN: 9781975150723 - Google Books
- 8. John R. Goldblum, Laura W. Lamps, Lauren Vedder Ackerman et al. Rosai and Ackerman's Surgical Pathology. (2017) ISBN: 9780323263399 - Google Books
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