Testicular lymphoma

Last revised by Henry Knipe on 1 Apr 2023

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

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 is preferred treatment 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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Cases and figures

  • Case 1: secondary involvement DLBCL
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  • Case 2: secondary involvement DLBCL
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  • Case 3
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  • Case 4: primary
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  • Case 5: secondary
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  • Case 6: primary testicular lymphoma
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  • Case 7: secondary scrotal involvement
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