Imaging of primary testicular lymphoma with unusual intraabdominal spread along the spermatic cord and gonadal vein

Abstract

Primary testicular lymphoma (PTL) is a rare Testicular neoplasm found in elderly patients. Imaging features in PTL presenting with contiguous involvement of spermatic cord and extension along gonadal vein have been rarely detailed before. We describe a case of a 50-year-old male who presented with complaints of scrotal swelling and abdominal discomfort. Imaging, which included Ultrasonography and contrast-enhanced computed tomography of chest-abdomen, showed features of aggressive-looking bilateral testicular mass lesions with the distinctive feature of contiguous spread along the spermatic cord and gonadal vein till retroperitoneum and disseminated chest and abdominal metastases. The distinctive feature of contiguous extension along the spermatic cord and gonadal vein can help suggest a diagnosis of PTL on imaging.

Concomitant Presence of Spermatic Cord and Testicular Non-Hodgkin's Lymphoma With Recurrence: A Case Report on a Rare Entity

“…Most of these cases come under the umbrella of diffuse large B-cell non-Hodgkin’s lymphoma, which is the most common histological type [ 2 ], with other types including Burkitt and follicular variants. Mid to old-aged men are predominantly affected by this variant of malignancy [ 1 , 5 - 6 ].…”

“…In post-contrast studies, the lesion mostly replaces the testis and epididymis parenchyma and is usually associated with a hydrocele. CT is further used to visualize para-testicular spaces and staging for which the Arbor classification is used [ 6 ]. MRI shows hypointense signals in the lesion on both long and short TE/TR sequences [ 5 , 9 ], with a moderate to strong diffusion restriction on diffusion-weighted sequences and subtle enhancement [ 9 ] after contrast administration.…”