Testicular lymphoma

Last revised by Mohammad Taghi Niknejad on 25 Feb 2025

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.

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

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.

Diffuse large B-cell lymphoma (DLBCL) accounts for the majority (~80%) of cases. Extranodal involvement is common, especially 3,4:

  • Waldeyer ring

  • skin and subcutaneous tissues

  • central nervous system

  • contralateral testis

  • lung

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.

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

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.

For ultrasound appearances, consider 4:

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