A Case of Extranodal Testicular Involvement in Non-Hodgkin's Lymphoma Detected through 18F-FDG PET-CT.

Abstract

A 69 year-old patient was admitted for constipation and with a three days history of left lumbar pain radiating into the left iliac fossa. Contrast enhanced abdominal CT (not illustrated) demonstrated a large retroperitoneal conglomerate (7 × 10 cm) of lymph nodes developing around the abdominal aorta from the level of the renal hilum to the iliac arteries bifurcation. Additional chest CT (not illustrated) confirmed another large conglomerate of enlarged lymph nodes in the superior mediastinum. Smaller nodes were also found in the cervical thoracic angles. The definite diagnosis of diffuse large B cell non Hodgkin lymphoma suggested by CT was confirmed by surgical biopsy of a cervical node. Complementary 18F-FDG PET-CT not only confirmed the typical high FDG uptake of the cervical, mediastinal (black arrows on Fig. A) and retroperitoneal (white arrow on Figs. A & B) of lymph nodes but unexpectedly revealed a high FDG uptake of the right testis (black arrow Fig. B) suggesting associated extranodal testicular extension. Colour Doppler Ultrasound of the moderately enlarged but clinically painless right testis revealed a typical hypoechogenicity of the organ (white star on Fig. C) with massive hypervascularity. Associated swelling and hypervascularity of the epididymis (black star on Fig. C) and vas deferens (grey arrow on Fig. C) were found. The patient is actually treated with classical CHOP chemotherapy regimen and drastic reduction of testi cular hypervascularity was already found after 3 courses of chemotherapy (not illustrated)