Primary Testicular Lymphoma Involving the Spermatic Cord and Gonadal Vein

Abstract

We report a case of a 70-year-old man with a history of prostatic adenocarcinoma and a 3-month history of right hemiscrotal swelling. The patient underwent a CT scan, scrotal ultrasound, and F-18 FDG-PET scan to evaluate for metastatic prostate cancer. The CT scan demonstrated an ill-defined soft-tissue mass extending along the right gonadal vein. Scrotal ultrasound revealed a heterogeneous right testicular mass. The F-18 FDG-PET scan demonstrated intense hypermetabolic activity along the course of the right gonadal vein extending to the right hemiscrotum. Subsequent right radical orchiectomy and pathologic examination revealed a B-cell lymphoma, infiltrating the testicular parenchyma, spermatic cord, gonadal vessels, and adjacent soft-tissues. Lymphoma or other tumors rarely infiltrate the spermatic cord, and have only very rarely been demonstrated on PET imaging.

FDG PET/CT of Bilateral Testicular Lymphoma

“…[1][2][3][4] The F-18 FDG PET or PET/CT scan could demonstrate primary testicular lymphoma infiltrating adjacent tissues and tumor relapse in the contralateral testis or spread to other organs. [5][6][7][8][9] Our case demonstrated that FDG PET/CT could detect the testicular lymphoma and extranodal spreading to regional lymph nodes and noncontiguous extranodal sites.…”

Non-Hodgkin Lymphoma Dominated by Multiple Organ Extranodal Disease Revealed on FDG PET/CT

“…Extranodal lymphoma has been reported to originate from almost every anatomic site of the body. [1][2][3][4][5][6][7][8][9] Nevertheless, the definition of extranodal lymphoma, particularly in the presence of both nodal and extranodal disease, remains a controversial issue, and different criteria have been proposed in the past to categorize these entities. 10,11 FDG PET/CT findings of extranodal lymphomas involving such organs as breasts, 12,13 stomach, 14,15 pancreas, 16 liver, 17,18 muscles, 19 kidneys, 20,21 bones, 22,23 and ovaries 24 have been reported before, the origin of extranodal disease being commonly ascribed to 1 given organ system or site.…”

Testicular fluorine-18 fludeoxyglucose uptake on positron emission tomography CT in patients with lymphoma: clinical significance and management impact

“…There was also significant variation in the pattern of testicular uptake comprising focal, multifocal and diffuse asymmetric/symmetric patterns, as reported previously. 13,14,18 Abnormal diffuse symmetrical uptake may be less indicative of malignant infiltration and more likely to be owing to a diffuse inflammatory process, such as bilateral idiopathic granulomatous orchitis (Patient 9). This study confirms that the presence of abnormal testicular uptake pattern on PET warrants further assessment.…”

“…12 However, there is a paucity of literature, limited to several case reports, evaluating the pattern, prevalence and clinical significance of abnormal testicular 18 F-FDG uptake on PET in patients with lymphoma. 13,14 To our knowledge, this is the first study of its kind examining the clinical and management impact of abnormal testicular 18 F-FDG uptake on PET in patients with lymphoma. The role of 18 F-FDG PET-CT in the diagnosis of testicular lymphoma and its management will also be discussed.…”