Testicular Lymphoma: Clinical and Imaging Features
N Pattamapaspong, K Khomarwut, C Ya-In, B Lojanapiwat, M Muttarak
Hong Kong J Radiol 2016;19:4-9
DOI: 10.12809/hkjr1615350
Objective: To review the clinical presentation and imaging features of testicular lymphoma.
Methods: We retrospectively reviewed the clinical data, and grey-scale and colour Doppler ultrasound features of 11 patients with proven testicular lymphoma between January 2000 and September 2013. The patients were aged 35 to 84 years (mean, 59 years). The diagnosis was established by orchidectomy in eight patients, by compelling evidence including bone marrow and lymph node biopsy in two, and autopsy in one.
Results: Of the 11 patients, seven presented with painless scrotal mass(es), three presented with an afebrile painful scrotal mass, and one presented with a febrile painful scrotal mass. Disease was unilateral in nine patients and bilateral in two. Primary testicular lymphoma was diagnosed in six patients and secondary testicular lymphoma in five, of which nine were non-Hodgkin’s lymphoma with diffuse large B-cell lymphoma (DLBCL) and two were T-cell lymphoma. Ultrasonography revealed diffuse hypoechoic involvement in seven patients, a solitary hypoechoic mass in two patients, and bilateral multiple hypoechoic masses in two patients. All lesions showed hypervascularity. Enlarged epididymis with hypervascularity was present in two patients mimicking epididymo-orchitis.
Conclusion: Testicular lymphoma is predominantly DLBCL. Patients may present with painless or painful scrotal mass(es). Lymphoma should be considered in a man older than 50 years who presents with testicular mass regardless of pain with focal or diffuse hypervascular hypoechoic testicular lesion(s) on ultrasound. The associated hypervascular enlarged epididymis does not exclude the diagnosis of testicular lymphoma.
中文摘要
睾丸淋巴瘤的臨床和影像學特徵
N Pattamapaspong, K Khomarwut, C Ya-In, B Lojanapiwat, M Muttarak
目的：探討睾丸淋巴瘤的臨床表現和影像學特徵。
方法：回顧分析於2000年1月至2013年9月期間共11個睾丸淋巴瘤確診病例的臨床資料，以及其灰度和彩色多普勒超聲特徵。患者年齡介乎35至84歲，平均59歲。患者中有8例經睾丸切除術而確診，2例經包括骨髓和淋巴結活檢等確診，另1例則通過屍檢而確診。
結果：11例睾丸淋巴瘤中，7例表現為無痛性陰囊腫塊，3例無發燒但有陰囊腫塊並感覺疼痛，1例有發燒症狀兼有陰囊腫塊和疼痛。單側睾丸淋巴瘤9例，雙側睾丸淋巴瘤2例。原發性和繼發性睾丸淋巴瘤分別有6例和5例。非霍奇金淋巴瘤併瀰漫性大B細胞淋巴瘤（DLBCL）9例，T細胞淋巴瘤2例。超聲檢顯示瀰漫性低迴聲病灶7例，孤立低迴聲病灶2例，雙側多發性低迴聲病灶2例。所有腫瘤病灶顯示高血管供應。患者中有2例出現附睾腫及富血管供應狀，與附睾睾丸炎相類似。
結論：睾丸淋巴瘤的種類主要為DLBCL。患者可以出現無痛或具疼痛感的陰囊腫塊。如果年齡超過50歲而超聲檢出現局灶性或瀰漫性富血管供應狀並有低迴聲病灶時，無論病人是否有疼痛現象，都應考慮淋巴瘤的可能性。富血管供應狀附睾並不排除睾丸淋巴瘤的可能性。