ABSTRACT
Natural killer/T cell lymphomas chiefly involving the midline facial structures including the nasal cavity or nasopharyns are a relatively rare type of non-Hodgkin's lymphoma. Apart from the upper respiratory tract, the disease occasionally presents in certain extranodal sites, such as the central nervous system, skin, gastrointestinal tract, or testes. We report a case of natural killer NK/T cell lymphoma as a testicular tumor in a 36-year-old man with a history of progressive swelling of his right testicle. Histologically, the testicular mass showed a diffuse infiltrate of medium-sized and atypical large lymphoid cells with angiocentric infiltration and areas of coagulative necrosis. Immunohistochemical studies demonstrated tumor cells staining positively with CD3, TIA-1, and Granzyme B. The Epstein-Barr virus genoma was detected by in situ hybridization. There were no abnormal findings in the nasal and nasopharyngeal regions. Classified as stage IEA, the patient received involved-field irradiation to contralateral testis (45 Gy), followed by systemic chemotherapy with a combination regimen ofL-asparaginase, methotrexate and dexamethasone. Relevant literature is reviewed, and the clinicopathologic features, natural history, and treatment options for primary testicular NK/T cell lymphoma are discussed.
ABSTRACT
Primary testicular non-Hodgkin’s lymphoma (NHL) is a rare, clinically aggressive form of extranodal lymphoma and constitutes 1% of all NHL and 5% of all testicular neoplasms. The vast majority of primary testicular lymphomas (PTLs) are diffuse large B-cell lymphoma (DLBCL); however, Burkitt’s lymphoma, anaplastic lymphoma, or Hodgkin’s lymphoma may primarily involve the testis but it is less common. High inguinal orchiectomy, along with chemotherapy with or without radiotherapy, is the current treatment of choice for these tumors. Here, we present the case of primary testicular NHL in a 72-year-old male.
ABSTRACT
This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma (PTL) patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival (PFS), overall survival (OS), and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage (III/IV) (P < 0.001), B symptoms (P < 0.001), and extranodal involvement other than testis (P = 0.001) were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS (OR = 11.58, P = 0.049), whereas B symptom was significantly associated with PFS (OR = 11.79, P= 0.049). In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months (P = 0.032). The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.
ABSTRACT
This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma (PTL) patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan-Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival (PFS), overall survival (OS), and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage (III/IV) (P < 0.001), B symptoms (P < 0.001), and extranodal involvement other than testis (P = 0.001) were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS (OR = 11.58, P = 0.049), whereas B symptom was significantly associated with PFS (OR = 11.79, P= 0.049). In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months (P = 0.032). The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Middle Aged , Antineoplastic Agents/therapeutic use , Asian People , China/epidemiology , Kaplan-Meier Estimate , Lymphoma/mortality , Prognosis , Progression-Free Survival , Retrospective Studies , Rituximab/therapeutic use , Survival Analysis , Testicular Neoplasms/mortality , Treatment OutcomeABSTRACT
Objective To investigate the clinical features, diagnosis, treatment and prognosis of primary testicular diffuse large B-cell lymphoma.Methods 8 patients with primary testicular diffuse large B-cell lymphoma were reviewed from April, 2012 to April, 2015.The mean age was 58 years old, ranging 43-68 years old.Color Doppler echocardiography examination showed that there were round or oval regular tumors in the scrotum, which the diameter ranged from 3.5 to 8.0 cm, mean 5.5 cm.There was no abnormal changes among abdomen and pelvic cavity in CT scan and tumor markers examination.The radical orchiectomy were performed in all patients.After opening the tunica vaginalis, a hard texture tumor could be found, which has the vague border line with normal tissue.All patients were diagnosed according to the combination of morpbologic and immunohistochemical examination after operating.Results All patients accepted operation successfully.The mean operation time was 34 minutes, ranging 25-40 minutes.8 cases were diagnosed as primary testicular diffuse large B-cell lymphoma after operating.Immunohistochemical analysis showed that CD20, BCL-6 were positive.CD3, CD10, CK were negative.All patients received adjuvant chemotherapy with RCHOP(cytoxan 750 mg/m2, adriamycin 50mg/m2, leurocnstine 1.4 mg/m2, prednisone 60 mg/m2 ,rituximab 375 mg/m2) regimen over 6 cycles, which was conducted once every three weeks, one week post-operatively.The follow up duration ranged from 6 to 36 months, mean 17 months.All patients survived at the end of this study with no sign of recurrence and metastasis.Conclusions The patients with primary testicular diffuse large B-cell lymphoma are rare.The radical orchiectomy is recommended.And RCHOP chemotherapy should be considered one week post-operatively.The short term outcome of the treatment is satisfactory.But the long term outcome should be further studied.
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Primary testicular lymphoma (PTL) is an uncommon extranodal presentation constituting 1% of all NHL and 5% of all testicular neoplasm. The objective of our study was to identify the presenting signs and symptoms, treatment and outcome of patients with testicular lymphoma diagnosed at the Hematology department of Farhat Hached University Hospital from 1997 to 2007 and to perform bibliography review about this pathology. Eleven cases were identified; the median age was 61 years (range:31-83). All patients presented with testicular and scrotal swelling or mass. B symptoms (recurrent fever of>38ºC temperature, night sweets and unexplained weight loss of>10% of the body weight within six months prior to diagnosis) were present in 6 patients. According to the "Ann-Arbor staging system", 7 patients were classified stage IE( involving a single lymph node region (I) or single extralymphatic organ or site) and IIE (two or more involved lymph node regions on the same side of the diaphragm (II) or localized involvement of an extralymphatic organ or site), 4 patients were classified stage IVE (the presence of diffuse or disseminated involvement of one or more extralymphatic organs (e.g., liver, bone, marrow, lung), with or without associated lymph node involvement). International Prognostic index was low (<2) in 7 patients and high (≥2) in 4 cases. Orchidectomy was performed in all cases. Eight patients received chemotherapy based on COP (2cases), mini CEOP (3 cases), ACVBP (2 cases). Eight patients received central nervous system prophylaxis in the form of intrathecal methotrexate. Radiation at the dose of 40Gy was given to 3 patients. Three patients achieved complete remission. Two patients relapsed. The median survival was 3 months (range: 1 week-107 months). Testicular lymphoma is a rare and deadly form of extra nodal lymphoma, randomized prospective treatment trials may help to establish better treatment strategies.
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Primary testicular lymphomas (PTL) are rare entities representing 1-2% of Non-Hodgkin's Lymphoma (NHL) and 1-7% of malignant testicular tumours. They are most commonly seen in men older than 60 years. The most common type of primary testicular lymphoma (PTL) is diffuse large B-cell type which has the potential for aggressive clinical behaviour. We report the case of a 45 years old male with primary testicular lymphoma which was first diagnosed on Fine Needle Aspiration Cytology (FNAC) and subsequently confirmed histopathologically and immunophenotypically as Diffuse Large B-Cell Lymphoma (DLBCL) showing CD20 positivity. This case report confirms the literature data concerning the rarity of testicular Non Hodgkin's Lymphoma (TNHL) with DLBCL being the most common phenotype and the poor prognosis of the disease despite aggressive management.
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Primary testicular lymphoma (PTL) is an uncommon extranodal lymphoma,with an aggressive clinical course and poor outcome.A combined treatment with full-course anthracycline-based chemotherapy with rituximab and central nervous system prophylaxis with intrathechal methotrexate and contralateral testicular radiotherapy should be considered as the standard of care at limited stage.These patients have a very high risk of central nervous system recurrence and the addition of systemic central nervous system prophylaxis with intravenous methotrexate may be the best treatment option.Primary central nervous system lymphoma (PCNSL) is an aggressive disease with a dismal prognosis,particularly when treated with established protocols used for systemic non-Hodgkin lymphoma.Use of methotrexate in combination with cytarabine has been proposed as a standard induction regimen.The role of the anti-CD20 antibody has not yet been defined,however,phase Ⅰ and Ⅱ trials suggest its efficacy despite low penetration within the cerebrospinal fluid.High-dose chemotherapy followed by autologous stem cell transplantation has shown high remission rates with 3-year overall suvival rates of up to 87 ％.
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BACKGROUND: Primary testicular diffuse large B-cell lymphoma (DLBCL) is a rare but aggressive extranodal lymphoma, and its relapse in the central nervous system (CNS) is a major concern during treatment. Despite this, the role of intrathecal prophylaxis in primary testicular DLBCL remains controversial. METHODS: We retrospectively reviewed the medical records of 14 patients with primary testicular DLBCL diagnosed between November 2000 and June 2012, and analyzed the CNS relapse rate in patients treated without intrathecal prophylaxis. Survival curves were estimated using the Kaplan-Meier method. RESULTS: The median age at diagnosis was 57 years (range, 41-79 years). Unilateral testicular involvement was observed in 13 patients. Nine patients had stage I, 1 had stage II, and 4 had stage IV disease. The international prognostic index was low or low-intermediate risk in 12 patients and high-intermediate risk in 2 patients. Thirteen patients underwent orchiectomy. All the patients received systemic chemotherapy without intrathecal prophylaxis, and prophylactic radiotherapy was administered to the contralateral testis in 12 patients. The median follow-up period of surviving patients was 39 months (range, 10-139 months). Median overall survival was not reached and the median progression-free survival was 3.8 years. Four patients experienced relapse, but CNS relapse was observed in only one patient (7.1%) with stage IV disease, 27 months after a complete response. CONCLUSION: Even without intrathecal prophylaxis, the rate of relapse in the CNS was lower in the Korean patients with primary testicular DLBCL compared to prior reports.
Subject(s)
Humans , Central Nervous System , Diagnosis , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Lymphoma , Lymphoma, B-Cell , Medical Records , Orchiectomy , Radiotherapy , Recurrence , Retrospective Studies , TestisABSTRACT
Primary testicular lymphoma comprises 1% to 9% of testicular neoplasms and represents 1% to 2% of all non-Hodg-kin lymphomas. Histologically, the majority of the tumor consists of diffuse large B-cell non-Hodgkin lymphomas that are of intermedi-ate- or high-grade neoplasm. Clinically, the disease typically presents as a painless testicular swelling that develops over a span of weeks to months. B symptoms such as fever, weight loss, and anorexia are present in 25% to 41% of the patients. This tumor is an ag-gressive type, with frequent invasion of the epididymis, spermatic cord, and scrotum, as well as a marked tendency to relapse, especial-ly in the CNS. The treatment is mainly based on orchiectomy (mostly in stages ⅠE and ⅡE) regardless of its association with prophy-lactic irradiation of the scrotum and administration of intrathecal chemotherapy, cyclophosphamide, doxorubicin, vincristine, and pred-nisone regimen chemotherapy plus rituximab (R-CHOP) (stages ⅢE and ⅣE) and radiotherapy. The multi-modality treatment marked-ly improved progression-free and overall survival. We introduce as reference one case that received a multidisciplinary comprehensive discussion in the Department Lymphoma, Tianjin Medical University Cancer Hospital.
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Objective Concluding the clinical feature and prognosis of primary testicular lymphoma to improve the understanding of this disease.Methods During 1995 and 2010,17 cases of primary testicular lymphoma treated in Beijing Friendship Hospital of Capital Medical University were retrospectively analyzed of its clinical features,diagnosis,treatment and prognosis.Results Seventeen patients with a mean age of 68 years complained the testicular sohd mass as their first symptoms.The mean tumor diameter was 4.7 cm,and all patients underwent orchidectomy,and testicular non- Hodgkin's lymphoma was confirmed by pathologic examination.Fourteen cases were diffuse large B cell type and 3 cases were anaplastic large cell type.The clinical stage of all the patients was IE.Fourteen cases were followed up (3 cases were lost)with mean follow-up time of 37.8 months by outpatient interview and telephone,all patients were treated with CHOP chemotherapy,and some of them were combined with rituximab and preventive lowdose pelvic radiotherapy.Five cases died of other chronic medical complications,1 case with contralateral testicular metastasis received surgery again.There were 9 tumor free survival cases in total.Conclusion Primary testicular lymphoma is rare and more common in older men.Postoperative pathologic diagnosis is gold standard.The systemic treatment and individual therapy is the first choice for primary testicular lymphoma.
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Objetivos: Comunicar un caso de un tumor de células NK de tipo nasal originado en el testículo y realizar una revisión de la literatura publicada. Método/Resultado: Presentamos un paciente de 68 años de la edad, sin historia urológica previa, que acudió a nuestra consulta refiriendo desde hace 11 meses clínica de inflamación del teste derecho y afectación de la piel escrotal con mala respuesta a tratamiento antibiótico. Se realizó una orquiectomía por vía inguinal y se resecó la piel afectada. El diagnóstico histológico definitivo fue de linfoma no Hodgkin tipo NK nasal de células grandes. Posteriormente fue derivado al servicio de hematología que realizó un estudio de extensión confirmando con un frotis sanguíneo el diagnóstico de linfoma y tras estudiar al paciente se realizó un tratamiento sistémico con 3 ciclos de CHOP y profilaxis intratecal. Tras 20 meses de seguimiento desde el inicio de los síntomas el paciente no ha presentado afectación ganglionar o de algún otro órgano. Conclusiones: Los linfomas de células T/NK nasales son tumores poco frecuentes en nuestro medio siendo su presentación extra nasal toda una rareza y encontrado en la literatura revisada sólo 12 casos de esta presentación testicular. Es esencial el estudio anatomopatológico mediante inmunohistoquímica para clasificar dichos linfomas, ya que este tipo se caracteriza por una rápida diseminación sistémica y mala respuesta al tratamiento.
Objectives: To report a case of a nasal type NK cell tumor originated in the testicle and review the published literature. Method/Results: We report a 68 years old patient, without previous urological history, who came to our clinic referring clinical inflammation of the right testicle with scrotal skin involvement for eleven months, with poor response to antibiotic treatment. Inguinal orchiectomy was performed with resection of the affected skin. The definitive histologic diagnosis was nasal type NK large cell non-Hodgkin lymphoma. He was subsequently referred to Hematology which conducted an extension study and confirmed the lymphoma diagnosis with a blood smear. After staging, the patient underwent systemic treatment with 3 cycles of CHOP and intrathecal prophylaxis. After 20 months follow up from the onset of symptoms the patient has had no lymph node or other organ involvement. Conclusions: Nasal type T/NK cell lymphoma tumors are infrequent being extranasal presentation a rarity. We found only 12 cases of this testicular presentation in the literature. Pathological analysis using immunohistochemistry is essential to classify these lymphomas, as rapid systemic spread and poor response to treatment is characteristic is essential to classify these lymphomas, as rapid systemic spread and poor response to treatment is characteristic.
Subject(s)
Humans , Male , Aged , Lymphoma, Non-Hodgkin , Testicular NeoplasmsABSTRACT
Objective To discuss the clinical features and prognostic factors of primary testicular lymphoma (PTL). Methods A retrospective review was performed based on the clinical records of 33 PTL cases treated at Tianjin Medical University Cancer Hospital from June 1977 to May 2009.Drawing survival curves by Kaplan-Meier method, using Log-rank test to the univariate analysis, and multivariate analysis by COX regression model to evaluate independent prognostic factors. Results The median age of patients was 62 years at presentation(range 33-81 years). Painless testicular swelling was the initial symptom. The majority of histological subtype was B cell lymphoma, 48% of which was diffuse large B-cell non-Hodgkin's lymphoma. By postoperative chemotherapy and/or radiotherapy, 23 patients achieved complete remission and 7 achieved partial remission, with a median follow-up of 23 months (4-231 months). The 5 years and 10 years of overall survival was 39.1% and 19.5%. The effect of patients who received chemotherapy≥4 cycles and B cell lymphoma patients combination with Rituximab were better. In multivariate analysis, Ann Arbor stage, B symptoms, age of patient and number of extranode site were independent prognostic factors of survival. Conclusions Primary non-Hodgkin lymphoma should be treated with multi-modality strategies. Treatment with doxorubicin-based chemotherapy after orchiectomy should be recommended. Ann Arbor stage, B symptoms, age of patient and number of extranode site were independent prognostic factors of survival in PTL.
ABSTRACT
Primary testicular lymphoma account for 1~5% of all testicular neoplasms. The majority of these tumors are diffuse large B-cell non-Hodgkin lymphoma. Primary NK/T cell lymphoma of the testis is a rare entity. Regardless of treatment, the majority of these patients have exhibited a highly aggressive clinical course and they have died within 1 year because of early dissemination. We report here on a case of the aggressive 'nasal type' natural killer (NK)/T cell lymphoma that initially presented as a testicular tumor. A 63-year-old man presented with painless left testicular swelling, and so a left orchiectomy was performed. A biopsy specimen of the testis revealed an extranodal NK/T cell lymphoma of the nasal type. In-situ hybridization for Epstein-Barr virus proved positive. The patient received systemic chemotherapy with 3 courses of a combination regimen.
Subject(s)
Humans , Middle Aged , B-Lymphocytes , Biopsy , Chimera , Herpesvirus 4, Human , Lymphoma , Lymphoma, Non-Hodgkin , Orchiectomy , Testicular Neoplasms , TestisABSTRACT
El linfoma no-Hodgkin (LNH) es la neoplasia testicular más común en hombres viejos y rara en hombres jóvenes. La gran mayoría de los linfomas primarios de testículo (LPT) es clasificada como linfomas de grado intermedio o alto. Objetivo: describir las características clínicas, morfológicas e inmunofenotípicas de los LPT atendidos en un hospital de referencia. Material y métodos: de 1986 a 1999 se revisaron los casos de LPT. Se analizaron los datos clínicos, estudios de laboratorio, evolución, tratamiento y se realizaron cortes en blanco para estudios de inmunohistoquímica (IH). Resultados: se incluyeron 10 pacientes con diagnóstico de LPT. El promedio de edad fue de 62.3 años (margen 42-81), en nueve pacientes se realizó orquiectomía como modalidad terapéutica inicial. Otros tratamientos posteriores al diagnóstico fueron; quimioterapia (60%) y radioterapia (20%). Histológicamente, los testículos mostraron infiltración difusa por células grandes de estirpe linfoide. Basados en la clasificación de la REAL, todos los casos fueron clasificados como linfomas difusos de células grandes. En ocho casos se realizó estudio de IH; 7/8 tumores expresaron inmunofenotipo B y sólo un caso inmunofenotipo T.
Non-Hodgkin lymphoma is the most common primary testicular neoplasm of older men but is rare in young men. The vast majority of primary testicular lymphomas (PTL) are intermediate- to high-grade lymphomas. Objective: to describe the clinical, morphologic, and immunophenotypic characteristics of PTL seen in a referral center. Material and Methods: we reviewed the cases of PTL seen from 1986 to 1999. We obtained data of laboratory tests, clinical course, treatment, and immunohistochemical studies. Results: 10 patients with diagnosis of PTL were identified. Median age was 62.3 years (range 42-81 years), and nine patients underwent orchiectomy as initial therapeutic procedure. Other treatment modalities after diagnosis included combination chemotherapy (60%) and combination radiotherapy (20%). Histologically, testes showed diffuse dense infiltration of large lymphoma cells. All cases were classified as diffuse large cell lymphoma according to REAL classification. Eight cases were studied with use of paraffin-section immunoperoxidase, 7/8 tumors were B-lineage lymphomas, and one was a T-lineage lymphoma.