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Spermatic cord lymphoma: a case report and literature review.

Taguchi S, Takahashi S, Iida K, Mizutani T, Yamaguchi K, Tominaga T, Niwa N, Yoshimi M, Takahashi T, Homma Y - Case Rep Med (2012)

Bottom Line: It has a poor prognosis even in stage I or II disease when treated locally, therefore, multidisciplinary treatment for early stage is recommended.On the other hand, the treatment of choice for stage III or IV spermatic cord lymphoma remains to be determined.Here we report a new case of spermatic cord lymphoma, which was found in stage IV disease.

View Article: PubMed Central - PubMed

Affiliation: The Department of Urology, Mitsui Memorial Hospital, Tokyo 101-8643, Japan.

ABSTRACT
Spermatic cord lymphoma is a rare lethal disease. It has a poor prognosis even in stage I or II disease when treated locally, therefore, multidisciplinary treatment for early stage is recommended. On the other hand, the treatment of choice for stage III or IV spermatic cord lymphoma remains to be determined. It is said that spermatic cord lymphoma is clinicopathologically similar to primary testicular lymphoma, therefore the treatment of spermatic cord lymphoma has often been determined by reference to the recommended treatment for primary testicular lymphoma. Here we report a new case of spermatic cord lymphoma, which was found in stage IV disease. We also review thirty-three cases which have been reported as spermatic cord lymphoma to date, and discuss treatment options.

No MeSH data available.


Related in: MedlinePlus

Gross appearance of the surgical specimen showing a white 67 mm tumor around the left spermatic cord.
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Related In: Results  -  Collection


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fig2: Gross appearance of the surgical specimen showing a white 67 mm tumor around the left spermatic cord.

Mentions: In July 2010, a 62-year-old man visited an urologist with a complaint of a left intrascrotal mass and was placed under clinical observation without treatment. Two months later, a swelling of the right tonsil appeared, and he visited an otorhinolaryngologist. After a biopsy of the right tonsil, he was diagnosed with diffuse large B-cell lymphoma (DLBCL) and was admitted to our hospital. Physical examination showed that the right tonsil swelled up beyond the midline, right cervical and left supraclavian lymph nodes were palpable, and a 50-mm mass existed along the left spermatic cord. He also had night sweats. In the blood examination, high levels of serum soluble interleukin-2 receptor were detected (5290 U/mL). Ultrasonography showed a 50 mm tumorous lesion in maximum diameter in the left spermatic cord and a 5 mm mass in the right spermatic cord, respectively. Computed tomographic scan (CT) showed the swelling of the right tonsil and the enlargement of right cervical, left supraclavian, and para-aortic lymph nodes. 67 Ga scintigraphy showed intense uptake in the same lesions which were detected in CT, but no uptake in groins (Figure 1). Bone marrow aspiration showed a few large atypical cells that were positive for CD20 and negative for CD3, which suggests the invasion of lymphoma to the bone marrow. Based on these findings, he was clinically diagnosed as DLBCL at stage IVB (Ann Arbor Staging). In December 2010, he underwent left radical orchiectomy for confirming the diagnosis and mass reduction. Macroscopically, a white 67 mm tumor in maximum diameter existed around the left spermatic cord, but the testis and the epididymis were not involved (Figure 2). It consisted of proliferative large atypical lymphocytes (Figure 3). Immunohistochemistry revealed that the tumor cells were positive for CD20 and negative for CD3. Histopathological diagnosis was DLBCL of the left spermatic cord. As adjuvant therapy, he completed both 6 cycles of rituximab added to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and 4 cycles of intrathecal methotrexate (IT-MTX) for central nervous system (CNS) prophylaxis. Then, he also underwent radiotherapy (RT) to the right testis for prophylaxis of contralateral testicular relapse. CT performed 4 months after the orchiectomy showed that all lesions either disappeared or reduced, and that there was no new lesions.


Spermatic cord lymphoma: a case report and literature review.

Taguchi S, Takahashi S, Iida K, Mizutani T, Yamaguchi K, Tominaga T, Niwa N, Yoshimi M, Takahashi T, Homma Y - Case Rep Med (2012)

Gross appearance of the surgical specimen showing a white 67 mm tumor around the left spermatic cord.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3295330&req=5

fig2: Gross appearance of the surgical specimen showing a white 67 mm tumor around the left spermatic cord.
Mentions: In July 2010, a 62-year-old man visited an urologist with a complaint of a left intrascrotal mass and was placed under clinical observation without treatment. Two months later, a swelling of the right tonsil appeared, and he visited an otorhinolaryngologist. After a biopsy of the right tonsil, he was diagnosed with diffuse large B-cell lymphoma (DLBCL) and was admitted to our hospital. Physical examination showed that the right tonsil swelled up beyond the midline, right cervical and left supraclavian lymph nodes were palpable, and a 50-mm mass existed along the left spermatic cord. He also had night sweats. In the blood examination, high levels of serum soluble interleukin-2 receptor were detected (5290 U/mL). Ultrasonography showed a 50 mm tumorous lesion in maximum diameter in the left spermatic cord and a 5 mm mass in the right spermatic cord, respectively. Computed tomographic scan (CT) showed the swelling of the right tonsil and the enlargement of right cervical, left supraclavian, and para-aortic lymph nodes. 67 Ga scintigraphy showed intense uptake in the same lesions which were detected in CT, but no uptake in groins (Figure 1). Bone marrow aspiration showed a few large atypical cells that were positive for CD20 and negative for CD3, which suggests the invasion of lymphoma to the bone marrow. Based on these findings, he was clinically diagnosed as DLBCL at stage IVB (Ann Arbor Staging). In December 2010, he underwent left radical orchiectomy for confirming the diagnosis and mass reduction. Macroscopically, a white 67 mm tumor in maximum diameter existed around the left spermatic cord, but the testis and the epididymis were not involved (Figure 2). It consisted of proliferative large atypical lymphocytes (Figure 3). Immunohistochemistry revealed that the tumor cells were positive for CD20 and negative for CD3. Histopathological diagnosis was DLBCL of the left spermatic cord. As adjuvant therapy, he completed both 6 cycles of rituximab added to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and 4 cycles of intrathecal methotrexate (IT-MTX) for central nervous system (CNS) prophylaxis. Then, he also underwent radiotherapy (RT) to the right testis for prophylaxis of contralateral testicular relapse. CT performed 4 months after the orchiectomy showed that all lesions either disappeared or reduced, and that there was no new lesions.

Bottom Line: It has a poor prognosis even in stage I or II disease when treated locally, therefore, multidisciplinary treatment for early stage is recommended.On the other hand, the treatment of choice for stage III or IV spermatic cord lymphoma remains to be determined.Here we report a new case of spermatic cord lymphoma, which was found in stage IV disease.

View Article: PubMed Central - PubMed

Affiliation: The Department of Urology, Mitsui Memorial Hospital, Tokyo 101-8643, Japan.

ABSTRACT
Spermatic cord lymphoma is a rare lethal disease. It has a poor prognosis even in stage I or II disease when treated locally, therefore, multidisciplinary treatment for early stage is recommended. On the other hand, the treatment of choice for stage III or IV spermatic cord lymphoma remains to be determined. It is said that spermatic cord lymphoma is clinicopathologically similar to primary testicular lymphoma, therefore the treatment of spermatic cord lymphoma has often been determined by reference to the recommended treatment for primary testicular lymphoma. Here we report a new case of spermatic cord lymphoma, which was found in stage IV disease. We also review thirty-three cases which have been reported as spermatic cord lymphoma to date, and discuss treatment options.

No MeSH data available.


Related in: MedlinePlus