Primary Testicular Lymphoma a Rare Extra Nodal Involvement of NHL

Primary testicular lymphoma is a collection of neoplasms that constitutes only 1–9% of testicular tumors. Although uncommon in the general population, it is the most common type of malignant testicular tumor in men ≥50 years of age. There are various subtypes, including diffuse large B-cell lymphoma (DLBCL), Burkitt’s lymphoma and follicular lymphoma. In the adult testis, primary DLBCL represents the most frequent subtype of lymphoma (80–90%), whereas the majority of testicular lymphomas in children consist of secondary involvement by Burkitt’s lymphoma, DLBCL or lymphoblastic lymphoma. The typical clinical sign is a painless testicular mass of variable size that is usually unilateral. Primary testicular lymphoma may be identified during the initial presentation of primary or systemic malignant lymphomas, or during a clinical follow-up of patients with lymphoma. Historically, primary testicular lymphoma has been reported to exhibit a poor prognosis with an overall 5-year survival rate of 17–48%, particularly primary testicular DLBCL, whose clinical behavior has been reported to be aggressive and to demonstrate a high propensity to disseminate to the central nervous system (CNS) and skin at presentation and relapse. The underlying mechanisms responsible for this aggressive behaviour have yet to be elucidated. In the present study, a patient with primary testicular DLBCL was examined from histological examination and immunohistochemical staining in the diagnosis of testicular DLBCL.

Hyperosmolar Hyperglycaemic State and Diabetic Ketoacidosis in Nivolumab-Induced Insulin-Dependent Diabetes Mellitus

Nivolumab is a monoclonal antibody directed against programmed cell death-1 receptor. It has an increasing application in the treatment of various advanced metastatic cancers. The incidence of autoimmune side effects associated with such agents is expected to increase. New-onset autoimmune diabetes mellitus associated with immune checkpoint inhibitor treatment is rare, occurring in less than 1% of patients. Nivolumab-induced diabetes often presents as diabetic ketoacidosis, which could be life-threatening if not recognized and treated promptly. We present the case of a patient who developed severe diabetic ketoacidosis concomitant with hyperosmolar hyperglycaemic state (HHS) after receiving nivolumab for metastatic testicular lymphoma. Pre-nivolumab blood glucose levels were normal, apart from transient hyperglycaemia related to steroids as part of the chemotherapy protocol. The diagnosis was confirmed with extremely low C-peptide in the clinic.

Testicular lymphoma in inguinal hernia

Primary testicular lymphoma is a rare disease that has a higher incidence in patients over 60 years of age, presenting as an increase in volume in the inguinal region, which is usually painless and slow-growing. In the case that we present, it is a patient who was initially diagnosed with an indirect inguinal hernia due to the findings on examination and ultrasound, without presenting relevant findings in the laboratory studies, during the trans-operative we found testicular tumor compatible with diffuse large B-cell lymphoma, this being the most common variant of testicular lymphoma. This case emphasizes on importance of pre-operative suspicion in older age patients with increased volume in the groin region and without a clear diagnosis.

Contrast-Enhanced and Microvascular Ultrasound Imaging Features of Testicular Lymphoma: Report of Five Cases and Review Literature

Background: To retrospectively investigate the grey-scale, Doppler, contrast-enhanced and microvascular ultrasound of five patients with primary testicular lymphoma of our institute through review literature analysis.Methods: From January to November 2020, five patients with primary testicular lymphoma confirmed by histology were preoperatively investigated with a standardized sonographic protocol including contrast-enhanced and microvascular ultrasound.Results: Conventional ultrasound showed localized hypoechogenicity represented with solitary lesions(2 of 5), multiple lesions (2 of 5), or entire testicular involvement (1 of 5). And increased blood flow appeared by color Doppler ultrasound with straight vascular sign(4 of 5). In contrast-enhanced ultrasound images confirmed this pattern(4 of 5) and presented incresaed enhancement with enlarged range. On microvascular ultrasound imagings, all lesions were presented with straight and parallel course of intralesional vessels(5 of 5).Conclusions: Here, we identified the increased vascularity with enlarged range on contrast-enhanced ultrasound along with a linear nonbranching pattern by vascular sign on microvascular ultrasonographic of testicular lymphoma.

Fine Needle Aspiration Cytology of Primary and Secondary Testicular Lymphoma and its Clinical Mimickers- A Definite Indication

Albeit being rare, the testicular lymphoma is the most common testicular malignancy in elders. In early stages, its symptoms are non-specific and can mimic other underlying diseases. The available knowledge of cytology on this entity is not adequate. In case when a clinician comes across a testicular enlargement case, a decision has to be made when to send the patient for FNAC. Similarly, the pathologist who is assessing the patient should also make a decision whether to perform Fine Needle Aspiration Cytology (FNAC) on the patient or not, and what morphology is expected on cytological smears to be able to confidently call it testicular lymphoma. We have undertaken this study to serve the purpose of enhancing the sparse knowledge available on this disease, dealt with its multiorgan involvement, and explained how FNAC is a valuable utility in testicular enlargement cases in which serological markers of testicular malignancy are negative.