Bilateral primary testicular lymphoma.

To cite: Vassallo E, Pullicino R, Grech R, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-202997 DESCRIPTION A 56-year-old man presented to his general practitioner with a painless, rapidly growing left testicular mass over a period of 3 months. The patient was a known case of type II diabetes mellitus and hypertension with no relevant surgical history. He did not report any dysuria, fever or weight loss. On examination, there was bilateral diffuse, non-tender testicular enlargement without regional lymphadenopathy. Sonographic assessment revealed an enlarged left hypoechoic testicle measuring approximately 5 cm in width and 8 cm in length. It demonstrated a diffusely heterogenous infiltrative pattern (figure 1A) and increased internal Doppler flow (figure 1B). The right testicle measured 5 cm×6 cm with otherwise similar sonographic findings (figure 2A,B). These features are non-specific and the differential diagnosis includes orchitis, primary testicular tumours, leukaemia, testicular torsion and sarcoidosis. Histology is thus warranted to confirm the diagnosis. The patient underwent a left inguinal orchidectomy and was diagnosed with diffuse primary large B-cell non-Hodgkin’s lymphoma. A right orchidectomy was performed 1 month later. Bone marrow aspirate and trephine biopsy were normal and he was started on a dedicated chemotherapeutic regimen. Primary testicular non-Hodgkin’s lymphoma accounts for 1–2% of all non-Hodgkin’s lymphomas and 5% of testicular cancers. It affects older men (mean age 67 years) and the most common histological subtype is diffuse large B-cell lymphoma. Presentation is usually with a unilateral testicular mass and up to 90% have stage I/II disease at diagnosis with bilateral testicular involvement occurring in 35% of cases. Relapse and extranodal infiltration is common.