Testicular non-Hodgkin Lymphoma Research Articles

PRIMARY DIFFUSE LARGE B CELL LYMPHOMA OF TESTICULAR : A CASE REPORT

Objective: To report our experience in treating a case of Testicular non-Hodgkin Lymphoma. Case(s) Presentation: A 55-year-old man came to the urology outpatient clinic with complaints of an enlarged left painless testicle that was lumpy and heavy. Urological examination found left unilateral testicle enlargement testicle, the size measured 10x7x7 cm with firm borders, solid consistency, and no tenderness. The patient then was treated with left orchiectomy. Histology and Immunohistochemical examination found non-Hodgkin B cells (CD20+) high grade, non-GCB. Discussion: In this case, the patient was treated with orchiectomy followed by a CHOP chemotherapy regimen. However, there was an unusual presentation due to the suspicion of metastases through the findings of a tender lump in the left inguinal region which was further confirmed by histological and immunohistochemical examination. Conclusion: Primary testicular lymphoma with a subtype of DLBCL (Diffuse Large B-Cell Lymphoma) is a rare disease. Orchiectomy is the initial treatment option for Testicular non-Hodgkin Lymphoma followed by combination therapy of chemotherapy to improve the prognosis.
 Keywords: Orchiectomy, testicular lymphoma, testicular tumors.

Primary testicular T cell Non Hodgkin Lymphoma with unusual histomorphology: A rare case

Primary testicular non-Hodgkin lymphoma (NHL) is an uncommon extra nodal lymphoma presentation, constituting 1-2% of all lymphomas. Majority are of B-Cell type, with very few cases being primary T-Cell phenotype. A 28 years male presented with painless, unilateral testicular swelling with elevated serum LDH levels, beta HCG and AFP serum levels were within normal limits. Gross evaluation of high inguinal orchidectomy specimen showed an enlarged homogenous, grey white lobulated mass with adjacent entrapped testicular parenchyma. Microscopy showed diffuse sheets of medium sized, monomorphic atypical lymphoid cells with sparing of adjacent seminiferous tubules. A panel of Immunohistochemistry markers done were suggestive of T-Cell Non-Hodgkin Lymphoma. Testicular T cell NHL are extremely rare amongst the testicular lymphomas, constituting for 5% of all testicular tumours. This case is being presented for its rarity in literature, especially in young age group and the unusual histomorphology.

Primary Testicular Non-Hodgkin Lymphoma: A Retrospective Single Centre Experience of 26 Cases with Long Follow Up

Introduction: Primary testicular lymphoma is a rare and aggressive malignancy representing 1% to 2% of all non-Hodgkin lymphomas (NHL) and accounts for approximately 5% of all testicular tumors. The aim of this study was to analyse clinical characteristics, therapy and survival outcomes of patients with primary testicular lymphoma diagnosed at our hospital from 1998 to 2017, and to compare differences in survival based on Ann Arbor Stages. Methods: A retrospective patient chart review was done to analyse the patient clinical characteristics, therapy and survival outcomes. Survival was calculated using Kaplan-Meier survival analysis. Results: Twenty-six patients were included; the mean age was 85±6.7 years. All patients presented with testicular tumor. Of the 26 patients, 17 patients were stage I, one stage III, and 8 stage IV. Orchiectomy was performed in all patients. 8 patients received no further treatment. Of the remaining 18 patients, overall, 18 received systemic chemotherapy and 5 radiation therapy. Six patients received intrathecal chemotherapy prophylaxis. Seventeen patients achieved complete remission. Four patients achieved partial remission; one patient had no response. Eleven patients died. Median survival was 144 months and was statistically significantly different between early versus advanced stage (stage I/II: 144 months; stage III-IV: 73 months, p=0.006). Conclusion: Primary testicular lymphomas are a rare and aggressive malignancy of extranodal lymphomas. Survival was different in early stages I/II versus advanced stages III- IV. Randomized, multi-center prospective studies could help to establish better prognostic and multi-modal therapy strategies.

Isolated Central Nervous System Relapse After 10 Years in a Case of Primary Testicular Lymphoma Detected on 18F-FDG PET/CT

A 51-year-old male patient with a past history of right-sided primary testicular non-Hodgkin lymphoma (NHL) in 2003 was referred to our department with a clinical suspicion of relapse in the brain. The patient was previously managed with bilateral orchiectomy, targeted chemoimmunotherapy with R-CHOP regimen as well as neuroprophylactic chemotherapy with intrathecal methotrexate and cytarabine in 2003. He later started developing episodes of dull headache 10 months back. The patient was referred to our department for 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for restaging purpose. 18F-FDG PET/CT in this patient revealed a metabolically active hyperdense mass (Fig. 1a–g, arrows), involving the corpus callosum as well as the adjacent brain parenchyma on either side associated with peri-lesional oedema, giving an appearance identical to that of a butterfly glioblastoma [1]. There was no evidence of any other focus suggestive of metastasis within the neural axis including the meninges. Also, the rest of the scan was otherwise normal, with no evidence of disease relapse elsewhere. The patient underwent magnetic resonance imaging (MRI) of brain for further characterisation of the brain lesion, which revealed a hypointense, enhancing mass involving the splenium and body of the corpus callosum on either side of the midline with involvement of adjacent brain parenchyma and associated with mild-to-moderate vasogenic oedema suggestive of secondary central nervous system (CNS) lymphoma. Based on the antecedent history of testicular lymphoma and a serum lactate dehydrogenase (LDH) of 394 U/l (125–243 U/l) in this patient, a diagnosis of CNS relapse of the testicular lymphoma was made. As the tissue diagnosis procedure of the brain lesion to assess the clonal variance could not be performed, a distant possibility of a second primary lymphoma affecting the CNS cannot be ruled out in this patient. Subsequently, the patient has been instituted on chemotherapy and the treatment will be subsequently tailored as per the response of the patient to the therapy, which shall be evaluated through periodic PET/CT scans.

Diagnosis and treatment of primary testicular non-Hodgkin lymphoma

The primary testicular non-Hodgkin lymphoma, which has been first described in 1866, is a very uncommon type of urological neoplasia occuring mostly in the elderly ages. It only gives 5% of the testicular tumors, 2% of extranodal lymphomas, and barely 1% of all non-Hodgkin diseases. Patients with testicular non-Hodgkin lymphomas need prompt multidisciplinary aid because without treatment the outcome can be unfavorable. The authors discuss the attributes, diagnostic modalities and treatment options of the primary testicular non-Hodgkin lymphoma and present a case of a 68-year-old patient who underwent orchiectomy, chemo- and radiotherapy after having been diagnosed with the tumor. The follow-up PET-CT and cerebrospinal fluid analysis found no further sign of the disease, and complete remission has been achieved.

Clinicopathologic Characteristics and Clinical Outcomes in Patients with Testicular Non-Hodgkin Lymphoma

AbstractAbstract 5111 PurposeWe aimed to evaluate the clinicopathologic characteristics and clinical outcomes in patients with testicular non-Hodgkin lymphoma. Material and MethodsWe reviewed the medical records of 24 patients with testicular non-Hodgkin lymphoma diagnosed at the Asan Medical Center between November, 2000 and June, 2012. ResultsMedian age of the patients was 52 years (23–79 years). Histopathologic subtypes were as follows: DLBCL (n=18, 75%), Burkitt’s lymphoma (n=2, 8. 3%), extranodal natural killer/T-cell lymphoma (NKTCL) (n=2, 8. 3%), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) (n=1, 4. 2%) and T-cell lymphoblastic lymphoma (T-LBL) (n=1, 4. 2%). Ten patients (41. 7%) were in stage I, 1 patient (4. 2%) in stage II, and the other 13 patients (54. 2%) were in stage IV. Eastern Cooperative Oncology Group Performance Status (ECOG PS) was 1 in 22 patients (87. 5%) and >1 in 5 patients (20. 8%). Serum LDH levels were elevated in 14 patients (58. 3%). International Prognostic index (IPI) score was low (0–1) in 6 patients (25%), low-intermediate (2) in 8 patients (33. 3%), high-intermediate (3) in 7 patients (29. 2%), high (4–5) in 3 patients (12. 5%). B-symptoms were present in 4 patients (16. 7%). Bilateral testicular involvement was observed in 5 patients (20. 8%).Fifteen patients (62. 5%) underwent orchiectomy as an initial therapeutic and diagnostic procedure. All the patients underwent chemotherapy: R-CHOP (n=16, 66. 6%), CHOP (n=2, 8. 3%), and other regimens (n=6, 25%). None received intrathecal prophylaxis just except a T-LBL patient. Prophylactic radiotherapy to contralateral testis was given in 12 patients (50%).Twenty-one patients (87. 5%) achieved complete response. At a median follow-up duration of 22 months (1–139 months), 2 patients (8. 3%) showed disease progression and 7 patients (29. 2%) experienced disease recurrence; in the central nervous system (n=2, 8. 3%), regional lymph nodes (n=3, 12. 5%), bone marrow (n=1, 4. 2%), nasopharynx (n=1), skin (n=1), and testicular bed (n=1). Five patients (20. 8%) died of sepsis (n=3, 12. 5%) or progression of disease (n=2, 8. 3%). Median progression free survival and overall survival were 20 months (1–139 months) and 22 months (1–139 months), respectively.ECOG PS >1 (p=0. 015) and bilateral testicular involvement (p=0. 000) were associated with a significantly short progression free survival (PFS). ECOG PS >1 (p=0. 001), high-intermediate or high risk of IPI (p=0. 010), presence of B symptoms (p=0. 035), and bilateral testicular involvement (p=0. 001) were associated with a significantly short overall survival. ConclusionsTesticular lymphoma is a rare but aggressive extranodal lymphoma. High ECOG PS, high IPI, B symptom, and bilateral testicular involvement were associated with poor prognosis.Table 1Clinicopathologic characteristicsCharacteristicsNumber of patientsPercentage (%)Age (years)Median52Range23–79Histopathologic subtypesDLBCL1875NKTCL28.3BL28.3CLL/SLL14.2T-LBL14.2ECOG PS12187.5>128.3Serum LDHNormal1041.7Elevated1458.3IPILow625Low-intermediate833.3High-intermediate729.2High312.5B-symptomsPresent416.7Absent2083.3LocationUnilateral1979.2Bilateral520.8 Disclosures:No relevant conflicts of interest to declare.

Primary testicular non-Hodgkin’s lymphoma associated with hemophagocytic syndrome: Case report and review of the literature

Primary testicular non-Hodgkin's lymphoma (TNHL) was first described as a clinical entity in 1866. It is a rare disease which accounts for 1% of all non-Hodgkin's lymphoma, 2% of all extranodal lymphomas and 5% of all testicular neoplasms. Hemophagocytic syndrome (HPS) is a rare but distinct condition caused by inappropriate and dysregulated activation of the immune system. We report a 47-year-old man with primary TNHL who developed HPS four months after occurrence of scrotal swelling. To the best of our knowledge, primary TNHL associated with HPS has not previously been reported.

Primary Testicular Lymphoma

Primary testicular non-Hodgkin lymphoma (PTL) comprises around 9% of testicular cancers and 1–2% of all non-Hodgkin lymphomas. Its incidence is increasing and it primarily affects older men, with a median age at presentation of around 67 years. By far the most common histological subtype is diffuse large B-cell lymphoma, accounting for 80–90% of PTLs. Most patients present with a unilateral testicular mass or swelling. Up to 90% of patients have stage I or II disease at diagnosis (60 and 30%, respectively) and bilateral testicular involvement is seen in around 35% of patients. PTL demonstrates a continuous pattern of relapse and propensity for extra-nodal sites such as the central nervous system and contralateral testis. Retrospective data have emphasised the importance of prophylactic radiotherapy in reducing recurrence rates within the contralateral testis. Recent outcome data from the prospective IELSG-10 trial have shown far better progression-free and overall survival than historical outcomes. This supports the use of orchidectomy followed by Rituximab- cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP), central nervous system prophylaxis and prophylactic radiotherapy to the contralateral testis with or without nodal radiotherapy in patients with limited disease. Central nervous system relapse remains a significant issue and future research should focus on identifying the best strategy to reduce its occurrence. Here we discuss the evidence supporting combination chemotherapy and radiotherapy in PTL.

A rare case of primary extra-nodal large cell Non-Hodgkin’s Lymphoma of testis

Non-Hodgkin lymphoma (NHL) of the testes is an uncommon extranodal presentation with an incidence rate of 0.06 to 0.09 per 100,000 persons and accounts for about 1% of all NHLs and 5% of all testicular tumors. The disease typically presents in patients aged over 60 years and is the most common testicular tumor in patients older than 60 years. Rightand left-sided testicular involvement is equal in frequency and approximately 6% of testicular lymphomas will have bilateral involvement. Testicular NHL has a relapse site in the central nervous system (CNS). It is actually a rare disease. Our case showed typical features of NHL without any CNS involvement even after 5 years. The patient was offered a standard chemotherapy regimen without any radiotherapy.

Testicular Localization of Extranodal Multifocal Non-Hodgkin Lymphoma. Report of Two Cases, Review of the Literature and Clinical Considerations

The aim of our study is to describe two cases of testicular localization of non- Hodgkin Lymphoma associated with the involvement of other extranodal organs, and to investigate the possible causes of this association according to the evidences found in literature. Non-Hodgkin Lymphoma is extranodal in 25% of cases. Most of the times the organs involved are stomach, bowel, skin, central nervous system. About urological localizations, the most common is testis. Very rare is to find lymphoma in kidney, prostate, urinary bladder, and ureter. Testicular lymphoma is about 5% of testis malignancies; it is more frequent in the 7th and in the 8th decade. Metastases of testicular non-Hodgkin lymphoma are described also many years later, and also in distant organs. Primary forms are usually "diffuse large B cell", a high-grade histotype; metastatic ones often show Burkitt cells. The standard therapy used for non-Hodgkin Lymphomas does not reach testis and central nervous system, so that these sites are called "Therapeutic Shrines". Therefore, in order to prevent testicular localization, it is necessary to use radiotherapy, and for nervous system prophylaxis it is necessary to administer intrathecal chemotherapy. More than one localization of non-Hodgkin lymphoma simultaneously found may indicate not only a metastatic spread, but also a multicentric origin. We describe two patients who had one testis removed because of a big mass that turned out to be a non-Hodgkin lymphoma. The first patient had been treated for a non-Hodgkin lymphoma of maxillary sinus 20 months before. The second patient showed contemporary involvement of other organs. In both cases the different localizations of non-Hodgkin lymphoma showed the same histological features and cellular immunophenotype. It is important to underline that in the former patient staging TC, repeated many times, had always been negative, but physical examination of testis had been omitted, so that sinonasal localization, assumed to be the first one, really might have been the spread of an undetected testis lymphoma. In conclusion, in case of extranodal non- Hodgkin lymphoma or any other malignancies, manual or ultrasound examination of testis should never be omitted, because standard techniques of staging (TC, RMN, PET) cannot explore this organ.

Primary testicular non-Hodgkin lymphoma: A single institution experience from India

Primary testicular non-Hodgkin lymphoma (NHL) is an uncommon extra nodal presentation, constituting 1% of all NHL. Median age at time of presentation is 60 years. Anthracycline based chemotherapies are most frequently used. There is not enough data on use of monoclonal antibody (Rituximab) in testicular NHL. We screened approximately eight hundred and fifty NHL cases registered from January 2002 to May 2008 and found six primary testicular NHL patients. These six cases were analyzed for baseline clinical features, investigations, staging, treatment and outcome variables. Median age was 55 years (range 7-72 years) and median duration of symptoms was 3.5 months (range 1-8 months). All patients had testicular swelling and abdominal lymphadenopathy. Five patients (83%) had stage IV and one had stage IE disease. Majority had diffuse large B-cell histology (83%). All patients were treated with anthracycline based combination chemotherapy and CNS prophylaxis after local therapy except one pediatric patient who did not receive any local therapy. Four patients completed therapy and are on follow up while two patients having extensive disease with poor performance status died of neutropenic sepsis after 1-2 cycles of chemotherapy. The surviving four patients achieved complete remission and are without any recurrence with a median follow up of 26 months (1-78 months). Primary testicular NHL is an uncommon entity and with current combined modality treatment and CNS prophylaxis, the outcome may be as good as nodal NHL.

Clinical Features and Treatment Outcomes of Primary Testicular Lymphoma.

We investigated clinical features and clinical outcomes of patients with primary testicular non-Hodgkin lymphoma (NHL) between 1996 and 2006. Thirty-eight cases were identified from clinical records. The median age was 59 years (range 41–81). Disease was classified as stages I in 13 cases, stages II in 15 and stages III-IV in 10. Diffuse large B-cell lymphoma was diagnosed in 92% of cases. All patients received orchiectomy. Twenty-three (61%) had orchiectomy and chemotherapy, 13 (34%) had orchiectomy, chemotherapy and involved field radiotherapy. All chemotherapy regimens which were used to patients in this study contained an anthracycline. Central nervous system (CNS) prophylaxis was performed in 6 (16%) patients and 10 (26%) patients were received prophylactic irradiation or surgery on the contralateral testis. In 33 evaluable patients, 4 (12%) had immediate disease progression following orchiectomy or on systemic treatment. A complete response was seen in the remaining 25 (76%) patients, irrespective of treatment modality. The median duration of follow-up was 25 months (range 2.5–122). Recurrence occurred in 18 patients and the most frequent site (45%) was the CNS: 4 in brain parenchyma, 3 in meninges, and 1 in both. Nine (36%) patients relapsed following a complete response and median time to relapse was 10 months. Overall median progression free survival (PFS) was 21 months. Twelve (32%) patients were died during follow-up: 10 died of causes related to their lymphoma and 2 were treatment-related mortality. Estimated median overall survival (OS) was 45 months for the entire patients. Significant survival differences between low/low intermediate and high intermediate/high risk of IPI were observed in OS (p=0.001). Primary testicular NHL was frequent in older patients, and has a poor prognosis although large proportion of this disease was loco-regional stage. Most of patients have died of disease related causes and their frequent relapse site was brain or meninges. Therefore, additional CNS prophylaxis including cranial irradiation and intrathecal chemotherapy to chemotherapy and involved field irradiation after orchiectomy should be considered as an effective treatment modality for improving survival.

Localised non-Hodgkin lymphoma of the testis: The Sheffield Lymphoma Group experience

We evaluated clinical features, management and survival of patients with localised (stage 1E or 2E) testicular non-Hodgkin lymphoma (NHL) presenting to the Sheffield Lymphoma Group between 1972 and 2002. Thirty consecutive eligible patients were identified from the lymphoma database and clinical records of all were reviewed. Survival data were statistically analysed. The median age of patients was 74 years (range 38-87). Sixty-three percent were >70 years of age. The median duration of follow-up was 15 months (range 2.1-211). All patients had orchidectomy. Eleven (37%) had orchidectomy alone. Twelve (40%) had orchidectomy and chemotherapy, 4 (13%) had orchidectomy and radiotherapy. Three (10%) had orchidectomy, chemotherapy and radio-therapy. Five (17%) had immediate disease progression following orchidectomy or whilst on treatment. A complete response was seen in the remaining 25 (84%) irrespective of treatment modality. Seven (23%) of patients remain alive, with a median follow-up of 73 months (range 9.9-211). Six (20%) died of causes not related to their lymphoma. Twelve (40%) relapsed following a complete response and median time to relapse was 9 months. Only 1 of these relapses was in the central nervous system; 1 in bone, 1 in skin, 2 in the contralateral testis. The majority of relapses (58%) occurred in the lymph nodes. Primary testicular lymphoma is an uncommon and poor prognosis disease usually affecting older men. The data and experience available to guide the treatment strategies for testicular lymphoma are limited. However, the evidence points to a combined modality approach being the most likely effective treatment, comprising surgery, anthracycline-containing combination chemotherapy with or without prophylactic contralateral testis and regional lymph node irradiation.

High-Dose Methotrexate for Isolated Central Nervous System Relapse in Patients with Testicular Non-Hodgkin's Lymphoma

Four consecutive patients with testicular non-Hodgkin's lymphoma who initially achieved a complete response to treatment with standard combination therapy later developed isolated central nervous system (CNS) relapses. At the time of CNS relapse, staging evaluations were negative for lymphoma outside the nervous system in all 4 patients. These patients were treated with high-dose intravenous methotrexate alone, and a complete remission was achieved in all 4 patients.

Commentary on “High-Dose Methotrexate for Isolated Central Nervous System Relapse in Patients with Testicular Non-Hodgkin's Lymphoma”

Commentary on “High-Dose Methotrexate for Isolated Central Nervous System Relapse in Patients with Testicular Non-Hodgkin's Lymphoma”

Commentary on “High-Dose Methotrexate for Isolated Central Nervous System Relapse in Patients with Testicular Non-Hodgkin's Lymphoma”

Commentary on “High-Dose Methotrexate for Isolated Central Nervous System Relapse in Patients with Testicular Non-Hodgkin's Lymphoma”

Lamivudine and Glycyrrhizin for Treatment of Chemotherapy-Induced Hepatitis B Virus (HBV) Hepatitis in a Chronic HBV Carrier with Non-Hodgkin Lymphoma

We report a chronic hepatitis B virus (HBV) carrier with non-Hodgkin lymphoma (NHL) who developed HBV hepatitis following conventional dose chemotherapy and was successfully treated with lamivudine and glycyrrhizin. A 55 year-old male patient with primary testicular NHL (diffuse large B-cell type) relapsed. During the salvage chemotherapy, the patient showed elevated serum levels of transaminase and HBV-DNA due to HBV reactivation. Treatment with lamivudine, an antiviral nucleoside analog, was started at a dose of 100mg/day. Shortly after the treatment the HBV-DNA level was suppressed, and sustained elevation of transaminase levels were normalized after additional treatment with glycyrrhizin. This experience suggests that lamivudine combined with glycyrrhizin may be effective for controlling HBV replication and treating chemotherapy-induced HBV hepatitis in chronic HBV carriers with NHL.

Clinical Features of Testicular Non-Hodgkin's Lymphoma: Focus on Treatment Strategy

Testicular primary non-Hodgkin's lymphoma (NHL) is said to account for about 5% of all testicular tumors and about 2% of extranodular lymphoma. From a clinical standpoint, we reviewed testicular NHL of stage IE treated at our department over the past 18 years. Among the 865 cases of NHL, 19 (2.2%) were primary testicular NHL, stage IE. The 19 patients had a median age of 62 years (range 48-77 years), all had diffuse B-cell lymphoma. Of the 19 patients, 8 were treated with radiotherapy after high inguinal orchiectomy (Group I), 4 received both postoperative radiotherapy and chemotherapy (Group II), and 7 received additional prophylactic intrathecal chemotherapy (Group III). The 5-year survival rates for Groups I, II and III were 37.5%, 50%, and 100%, respectively. None of the patients receiving prophylactic intrathecal chemotherapy had relapse in the central nervous system and all of them are alive and disease-free. Primary testicular NHL is relatively common among elderly persons, and many patients die as a result of central nervous system recurrence. These results suggest that preventive measures for central nervous system recurrence such as intrathecal injection of anticancer agents should be taken into consideration as early as at the induction of remission.

Primary testicular non-Hodgkin's lymphoma: a clinical study and review of the literature.

Non-Hodgkin's lymphoma (NHL) of the testis is a rare disease, and treatment outcome is generally poor. In this retrospective study, we investigated treatment results for testicular NHL in an attempt to develop an effective treatment policy for this disease. The survival rate and characteristics were retrospectively analyzed in eight patients with NHL of the testis who were treated between 1969 and 1991 at Kyoto University Hospital, Department of Radiology. Four patients were at stage IEA, one at stage IIEA, and three at stage IVEA. Of the eight testicular lymphomas, six were classed as intermediate grade lymphomas and two as high-grade lymphomas according to the Working Formulation. All of the eight patients received orchiectomy. Six patients received combined chemotherapy and radiation therapy as the primary treatment for the disease. One patient each was treated with radiation therapy alone or combination chemotherapy alone. The 5-year overall and disease-free survival rate was 45 and 33%, respectively. Even though almost all of the patients had received combination chemotherapy, high incidence of relapse in the central nervous system (CNS) was observed. Prophylactic treatment against such recurrence may be necessary to improve the treatment outcome of patients with testicular NHL.

Testicular Non-Hodgkin's Lymphoma

Testicular Non-Hodgkin's Lymphoma