Testicular Lymphoma: Clinical and Imaging Features

Abstract

Objective: To review the clinical presentation and imaging features of testicular lymphoma. Methods and Materials: The Institutional Review Board approved this study and informed consent was waived. Between January 2000 and September 2013, we retrospectively reviewed clinical data, grey-scale and color Doppler ultrasound features of 11 patients with proven testicular lymphoma. The patients were 35-84 years (mean age, 59 years). The diagnosis was established by orchidectomy in eight patients and by compelling evidence including bone marrow and lymph node biopsy in three. Results: Seven patients presented with painless scrotal mass(es), three presented with afebrile painful scrotal mass, and one presented with febrile painful scrotal mass. The right testis was involved in four patients, left testis in five, and bilateral in two. Primary testicular lymphoma was diagnosed in six and secondary testicular lymphoma in five. Nine were non-Hodgkin lymphoma with diffuse large B-cell lymphoma and two were T-cell lymphoma. Ultrasound revealed solitary hypoechoic mass in two, bilateral multiple hypoechoic masses in two and diffuse hypoechoic involvement in seven. All lesions showed hypervascularity. Hydrocoele was present in seven and enlarged epididymis with hypervascularity was present in two. Conclusion: Testicular lymphoma are predominantly DLBCL, affecting men over 50 years of age. Patients may present with painless or painful scrotal mass(es). Lymphoma should be considered in a man older than 50 years who presents with painless or painful mass(es) with hypervascular focal or diffuse hypoechoic testicular lesion on US. The associated hypervascular enlarged epididymis may not preclude the diagnosis of testicular lymphoma.