睪丸淋巴癌-高齡族群易低估之惡性腫瘤
黃品叡、周詠欽、沈正煌、林昌德、鄭明進
戴德森醫療財團法人嘉義基督教醫院 外科部 泌尿科
Testicular lymphoma - an easily underestimated malignancy in geriatric patients
Pin-Jui Huang, Yeong-Chin Jou, Cheng-Huang Shen, Chang-Te Lin,Ming-Chin Cheng
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
Purpose: To evaluate the clinical features and outcomes of testicular lymphoma for patients receiving unilateral orchiectomy and follow-up with chemotherapy and radiotherapy at our hospital.
Material and Method: Between January 2005 to September 2019, a total of eight patients with testicular lymphoma which was diagnosed by final pathology of unilateral orchiectomy were enrolled in this study. Patients received chemotherapy or radiotherapy after operation. Patients were monitored for postoperative outcome.
Results: Of the eight patients, final pathology of seven patients (87.5%) reported primary diffuse large B cell lymphoma (DLBCL), while the other 1 patient was reported as metastatic NK/T-cell lymphoma. The average age of the patients was 68.9 year-old. One patient was lost to follow-up after surgery. The average follow-up duration was 7.8 months. The average progression free follow-up duration was 3.5 months. AFP and β-HCG level remained stable in all cases, with exception of one patient who had hepatocellular carcinoma had a higher level of AFP. Six patients were Ann Arbor stage I or II at diagnosis and two were stage III or IV. The mean IPI score at diagnosis was 2.1. Bulky disease was not identified in any of the patients. For seven patients with DLBCL, two patients received R-EPOCH chemotherapy. One patient received R-EPOCH and regional radiotherapy. Three patients received R-CHOP-14 (14-day cycle). One patient lost follow-up after operation. None of patient received prophylactic intrathecal chemotherapy. Complete remission was only achieved in one patient. Two patients were still undergoing chemotherapy during the last follow-up and had no sign of relapse. Partial remission was noted in four patients, but four of them still died during follow-up. Two patients died due to their underlying disease. One was lung cancer stage IV, and the other was HCC stage IV. Two patients died due to lymphoma, and both cases showed relapse in brain before death. Time to relapse were 1.3 and 1.6 months. One patient was lost follow-up after operation.
Conclusions: Orchiectomy stands as gold standard for testicular lymphoma, while local radiotherapy, chemotherapy and immunotherapy also played an important role in treatment.