Two Cases of Primary Testicular Lymphoma Presenting with Direct Spread along the Spermatic Cord and Gonadal Vessels

Abstract

Primary testicular lymphoma is a rare testicular neoplasm that mainly affects elderly patients, with Human Immunodeficiency Virus (HIV) being a known risk factor in the younger population. Approximately 20% of patients will have disseminated disease with extra-nodal involvement at clinical presentation. Rarely, direct spread along the spermatic cord and gonadal vessels can occur and has been described in the literature. We present two cases of this phenomenon where the primary testicular tumour has spread along the gonadal vein to its origin at the inferior vena cava.

Imaging of primary testicular lymphoma with unusual intraabdominal spread along the spermatic cord and gonadal vein

“…The most important finding in our case which sets it apart from those previously described is the contiguous involvement of spermatic cord and gonadal vein in the form of homogenously enhancing soft tissue extending along these structures on the left side. This finding has been described so far in only a few case reports in the available literature [4] , [5] , [6] .…”

“…This feature of contiguous spread of tumor along the spermatic cord and gonadal vein described in our case of Primary TNHL can serve as an important distinction between the two; as this is not a feature of secondary involvement in widespread NHL [4] , [5] , [6] . Only a few case reports exist so far detailing the feature of contiguous tumor spread along the spermatic cord and gonadal vein as a pathognomic feature of Primary TNHL [4] , [5] , [6] . Sabale et al [4] described 2 cases of Primary TNHL that showed extension of soft tissue along epididymis and spermatic cord into inguinal canal with further continuous extension along the gonadal vein up to inferior vena cava.…”

“…Sabarwal and Ismail [5] described a case of unilateral testicular mass with soft tissue seen to extend along the spermatic cord and infiltrate the gonadal vein. Ellatif et al [6] described 2 cases, both showing cord-like soft tissue extending in a contiguous fashion from the testicular mass onto the spermatic cord and gonadal vessels in the retroperitoneum.…”

“…It has a propensity to disseminate to extranodal sites such as the central nervous system, Waldeyer ring, lungs, pleura, soft tissues, and contralateral testis [1] . PTL presenting with contiguous involvement of spermatic cord and extension along gonadal vein is a rarely described occurrence detailed in only a handful of case reports till now [4] , [5] , [6] . Here, we present a case of an elderly male patient who had bilateral testicular involvement with contiguous extension along the spermatic cord and the gonadal vein till the retroperitoneum.…”

Direct Spread of Primary Testicular Lymphoma along the Gonadal Vessels Detected on F-18 Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography Imaging

“…Several case reports have shown a direct spread of PTL along the spermatic cord and gonadal vessels, and this has been proposed to be unique to PTL and not reported in other more common testicular tumors. [ 8 9 10 ] On CT, this is seen as contiguous abnormal soft tissue extending along the spermatic cord and the gonadal vessels, through the inguinal canal, and the retroperitoneum, to the level of insertion of the gonadal veins. [ 8 9 10 ] FDG PET/CT although has limited value in initial diagnosis and differentiation of PTL from other primary testicular neoplasms, it is the imaging modality of choice for identifying extratesticular involvement and staging/restaging of PTL.…”