Presentation
Craggy right testicle 3 times the size of normal.
Patient Data
Mixed echogenicity, ill-defined, heterogeneous mass with widespread internal vascularity replacing virtually the whole of the right testicle.
Normal ultrasound appearances of the left testis.
Case Discussion
The ultrasound appearances are of testicular malignancy. A right orchiectomy was undertaken.
Histology report
A right orchiectomy specimen comprises 110 mm of spermatic cord with testis 70 x 45 x 40 mm. The testis is almost completely replaced by a solid white tumor. There are no areas of cystic degeneration or necrosis. No residual normal testicular tissue is evident. The tumor appears limited within the testis itself. Serial slicing with spermatic cord appears normal. A = Cord RM B-F = Tumor G = Tumor (large block) Microscopic: The right testis is almost completely replaced by a high grade B cell lymphoma of probable diffuse large B cell subtype. The limited amount of background testis shows some areas of residual spermatogenesis with other areas showing atrophic changes. No germ cell neoplasia in situ is present. The testicular appendageal structures are normal. The spermatic cord contains perivascular aggregates of lymphoid cells with probable benign reactive germinal center formation. The morphology of this lymphoid component is markedly different to that within the testis and would appear reactive in nature. Precise subtyping of the lymphoma will require specialist review with additional immunohistochemistry as necessary.
Conclusion: High-grade B cell lymphoma.
Primary testicular lymphoma is one of the less common testicular malignancies. As in this case, it is typically in those ages 70 and above.
CT CAP did not identify any lymphadenopathy.
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