Presentation
The patient presented to urology outpatient clinic for assessment of slowly growing scrotal lump.
Patient Data
The lump, within the midline/left lower hemi-scrotum, is a well circumscribed heterogeneous mass measuring 11 x 13 x 16mm. This displays significant vascularity when color Doppler is applied, of unknown etiology.
Case Discussion
The patient developed a scrotal lump that grew slowly in the last few weeks. On examination, it was olive-sized, well-circumscribed, hard and freely mobile swelling in the midline scrotum, slightly to the left, with no skin involvement. The patient has a history of stage 4 diffuse large B cell lymphoma 6 years back that responded to chemotherapy, and a laparoscopic right hemicolectomy for management of colonic adenocarcinoma 7 years back.
Scrotal US was performed and it showed a vascular lesion of unknown etiology. Considering the medical history, the patient underwent surgical excision of the scrotal lesion. Histopathology revealed a non-Hodgkin B-cell lymphoma consistent with an extra-nodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type.
The neoplastic proliferation of B cells occurs either in the lymphoid tissue gives rise to marginal zone B cell lymphomas or in extra-nodal sites to mucosa-associated lymphoid tissue (MALToma) 1. The latter presents along the mucosal linings in the human body including the gastrointestinal tract, salivary gland, lacrimal gland, thyroid, dura mater, breast, skin, eyes and lung. Infective or autoimmune persistent immune stimulation leads to the development of MALTomas 2. In the literature, scrotal involvement might be not a common presentation.
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