睪丸瀰漫性大B細胞淋巴瘤之案例報告

梁柏崧、黃勝賢

彰化基督教醫院 外科部 泌尿外科

Diffuse large B cell lymphoma in testis: A case report

Po-Sung Liang, Sheng-Hsien Huang

Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Introduction: Diffuse large B cell lymphoma (DLBCL) in testis is a rare disease. We presented a case of 58-year-old man with DLBCL in testis treated with radical orchiectomy, followed by immunochemotherapy.  

Case presentation: A 58-year-old male with history of diabetes mellitus, hypertension and coronary artery disease presented to urologic clinic with left scrotal mass for 1 month. He denied, fever nor abdominal pain, but lower urinary tract symptoms including urinary frequency and weak urinary stream were noted. The scrotal sonography showed multiple hypoechoic intratesticular mass lesion with fluid accumulation around the left testis. There was no focal lesion at the right testis. Serum alpha-fetoprotein (AFP), lactate dehydrogenase (LDH) and beta-human chorionic gonadotropin (hCG) were checked for testicular cancer survey, and normal level was noted in all markers. The magnetic resonance imaging (MRI) was arranged for further survey and revealed a intratesticular mass of the left testis about 4.2cm in size, with relative homogenous intensity, relative isointensity on T1WI, relative low intensity on T2WI, and mild heterogeneous contrast enhancement. Seminoma was most likley, and other testicular tumor or inflammatory process should be ruled out. Then, he received resection and tissue proof of the mass. Left radical orchiectomy was subsequently performed. Pathological report showed DLBCL. The computed tomography (CT) of the chest and the MRI of the brain revealed no evidence of distant metastases. ¹⁸F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) was arranged for comprehensive tumor survey and revealed reactive change at bilateral hilar lymph nodes and post-operative change at left inguinal region and left scrotum. He was referred to medical oncologist, and immunochemotherapy with R-CHOP regimen (Rituximab + Cyclophosphamide + Epirubicin + Vincristine + Prednisolone) was arranged. There was no tumor progression in the 6-month follow-up.

Conclusions: DLBCL in testis is rare but clinically aggressive. As its non-specific clinical manifestation, it is often confused with other intratesticular tumor, which may lead to misdiagnosis and delay treatment. Urologists should pay attention to the possibility of the testicular lymphoma.