Limits...
Primary bilateral plasmablastic lymphoma of the testis in a human immunodeficiency virus positive man.

Badyal RK, Kataria AS - Indian J Sex Transm Dis (2015 Jan-Jun)

Bottom Line: On cytopathological and subsequent histopathological examination, the diagnosis of bilateral plasmablastic NHL was made.Extensive systemic work-up failed to reveal any disease outside the testes.Immune suppression rather than HIV itself is implicated in the pathogenesis of lymphomas.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Government Medical College, Amritsar, Punjab, India.

ABSTRACT
Human immunodeficiency virus (HIV)-related lymphomas are predominantly aggressive B-cells lymphomas. The most prevalent of the HIV-related lymphomas are diffuse large B-cell non-Hodgkin's lymphoma (NHL), which includes primary central nervous system lymphoma, and Burkitt lymphoma, whereas primary effusion lymphoma, plasmablastic lymphoma (PBL), and classic Hodgkin lymphoma are far less frequent. Of these, PBL is relatively uncommon and displays a distinct predilection for presentation in the oral cavity. In this manuscript, we report a primary testicular form of PBL in 44 year-old Border Security HIV positive patient who presented with bilateral testicular swelling of 1-year duration. On cytopathological and subsequent histopathological examination, the diagnosis of bilateral plasmablastic NHL was made. Extensive systemic work-up failed to reveal any disease outside the testes. Immune suppression rather than HIV itself is implicated in the pathogenesis of lymphomas. Herein, we report a case of PBL as AIDS-related malignancy presenting in testes and its correlation with CD4+ count.

No MeSH data available.


Related in: MedlinePlus

(a) Bilateral testicular enlargement (b) Computed tomography scan showing bilateral enlarged testes of heterogenous echotexture (c) Gross appearance of tumor, large grey white fleshy mass
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4555909&req=5

Figure 1: (a) Bilateral testicular enlargement (b) Computed tomography scan showing bilateral enlarged testes of heterogenous echotexture (c) Gross appearance of tumor, large grey white fleshy mass

Mentions: A 44-year-old Border Security Forces personnel, presented with a history of a progressive painful bilateral scrotal swelling of 1-year duration. He had high-grade intermittent fever associated with weakness, loss of weight, and appetite. On examination, he had pallor. There was no history of any noticeable lumps in other parts of the body. General physical examination was unremarkable, with no palpable lymphadenopathy or hepatosplenomegaly except for visible bilateral testicular enlargement [Figure 1a]. There was no history of use of immunosuppressive medications. He was diagnosed as HIV + by ELISA method. In the initial appearance of testicular swelling, CD4+ count was 103/mm3 and improved with antiretroviral therapy to 250/mm3. Ultrasound of the scrotum showed bilaterally enlarged testes of heterogenous echotexture and bilateral hydrocoele with enhancement on computerized tomography (CT) scan [Figure 1b]. Fine-needle aspiration cytology of both the testes was done and cytological smears showed atypical large lymphoid cells showing plasmacytoid and immunoblastic differentiation, having basophilic cell cytoplasm, eccentric nuclei with 1–2 prominent nucleoli [Figure 2a]. The possibility of large cell non-Hodgkin's lymphoma (NHL) with plasmablastic differentiation was suggested. Radiological evaluation with CT scan of chest and abdomen did not show any other focal lesion. Further evaluation, that is, bone marrow biopsy was done to exclude plasma cell dyscrasias, which was normal with no marrow infiltration. Serum and urine protein electrophoresis were normal. Based on progressive symptoms and increased size of the lesion, the patient underwent bilateral orchiectomy. Grossly the testes weighed 220 g and measured 8 cm × 5 cm × 3 cm and 6 cm × 4 cm × 2 cm with a large, white, fleshy, soft, slightly tan mass replacing almost the entire cut surface with no evident necrosis or hemorrhage [Figure 1c]. Microscopic examination showed diffuse sheets of highly atypical cells having large round nuclei, coarse chromatin, and 1 or 2 prominent nucleoli [Figure 2b]. There were foci of necrosis and mitotic activity was brisk. On immunohistochemistry, (IHC) tumor cells showed positivity for CD38 [Figure 2c], CD138 [Figure 2d], vimentin, and epithelial membrane antigen. Immunostains for CD45, CD20, ALK, PLAP, cytokeratin, and EBV were negative. Ki 67 index was 90%. The patient was diagnosed as having an extramedullary plasmablastic tumor most consistent with plasmablastic NHL. The patient was planned for chemotherapy, but because of his deteriorating functional status and low CD4+ counts, he died 1 month after diagnosis.


Primary bilateral plasmablastic lymphoma of the testis in a human immunodeficiency virus positive man.

Badyal RK, Kataria AS - Indian J Sex Transm Dis (2015 Jan-Jun)

(a) Bilateral testicular enlargement (b) Computed tomography scan showing bilateral enlarged testes of heterogenous echotexture (c) Gross appearance of tumor, large grey white fleshy mass
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555909&req=5

Figure 1: (a) Bilateral testicular enlargement (b) Computed tomography scan showing bilateral enlarged testes of heterogenous echotexture (c) Gross appearance of tumor, large grey white fleshy mass
Mentions: A 44-year-old Border Security Forces personnel, presented with a history of a progressive painful bilateral scrotal swelling of 1-year duration. He had high-grade intermittent fever associated with weakness, loss of weight, and appetite. On examination, he had pallor. There was no history of any noticeable lumps in other parts of the body. General physical examination was unremarkable, with no palpable lymphadenopathy or hepatosplenomegaly except for visible bilateral testicular enlargement [Figure 1a]. There was no history of use of immunosuppressive medications. He was diagnosed as HIV + by ELISA method. In the initial appearance of testicular swelling, CD4+ count was 103/mm3 and improved with antiretroviral therapy to 250/mm3. Ultrasound of the scrotum showed bilaterally enlarged testes of heterogenous echotexture and bilateral hydrocoele with enhancement on computerized tomography (CT) scan [Figure 1b]. Fine-needle aspiration cytology of both the testes was done and cytological smears showed atypical large lymphoid cells showing plasmacytoid and immunoblastic differentiation, having basophilic cell cytoplasm, eccentric nuclei with 1–2 prominent nucleoli [Figure 2a]. The possibility of large cell non-Hodgkin's lymphoma (NHL) with plasmablastic differentiation was suggested. Radiological evaluation with CT scan of chest and abdomen did not show any other focal lesion. Further evaluation, that is, bone marrow biopsy was done to exclude plasma cell dyscrasias, which was normal with no marrow infiltration. Serum and urine protein electrophoresis were normal. Based on progressive symptoms and increased size of the lesion, the patient underwent bilateral orchiectomy. Grossly the testes weighed 220 g and measured 8 cm × 5 cm × 3 cm and 6 cm × 4 cm × 2 cm with a large, white, fleshy, soft, slightly tan mass replacing almost the entire cut surface with no evident necrosis or hemorrhage [Figure 1c]. Microscopic examination showed diffuse sheets of highly atypical cells having large round nuclei, coarse chromatin, and 1 or 2 prominent nucleoli [Figure 2b]. There were foci of necrosis and mitotic activity was brisk. On immunohistochemistry, (IHC) tumor cells showed positivity for CD38 [Figure 2c], CD138 [Figure 2d], vimentin, and epithelial membrane antigen. Immunostains for CD45, CD20, ALK, PLAP, cytokeratin, and EBV were negative. Ki 67 index was 90%. The patient was diagnosed as having an extramedullary plasmablastic tumor most consistent with plasmablastic NHL. The patient was planned for chemotherapy, but because of his deteriorating functional status and low CD4+ counts, he died 1 month after diagnosis.

Bottom Line: On cytopathological and subsequent histopathological examination, the diagnosis of bilateral plasmablastic NHL was made.Extensive systemic work-up failed to reveal any disease outside the testes.Immune suppression rather than HIV itself is implicated in the pathogenesis of lymphomas.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Government Medical College, Amritsar, Punjab, India.

ABSTRACT
Human immunodeficiency virus (HIV)-related lymphomas are predominantly aggressive B-cells lymphomas. The most prevalent of the HIV-related lymphomas are diffuse large B-cell non-Hodgkin's lymphoma (NHL), which includes primary central nervous system lymphoma, and Burkitt lymphoma, whereas primary effusion lymphoma, plasmablastic lymphoma (PBL), and classic Hodgkin lymphoma are far less frequent. Of these, PBL is relatively uncommon and displays a distinct predilection for presentation in the oral cavity. In this manuscript, we report a primary testicular form of PBL in 44 year-old Border Security HIV positive patient who presented with bilateral testicular swelling of 1-year duration. On cytopathological and subsequent histopathological examination, the diagnosis of bilateral plasmablastic NHL was made. Extensive systemic work-up failed to reveal any disease outside the testes. Immune suppression rather than HIV itself is implicated in the pathogenesis of lymphomas. Herein, we report a case of PBL as AIDS-related malignancy presenting in testes and its correlation with CD4+ count.

No MeSH data available.


Related in: MedlinePlus