Testicular Lymphoma: Symptoms, Diagnosis, Prognosis, and Treatment

This entry looks at testicular lymphoma, or non-Hodgkin's lymphoma of the testis. 'Lymphoma' is an umbrella term that loosely refers to several dozen independent categorical types and subtypes of cancers of the lymphatic system; testicular lymphoma is one of those subtypes.

The disease is called primary testicular lymphoma (PTL) if it is found to originate in the testis. It is (less commonly) called secondary testicular lymphoma if the disease originates elsewhere in the body and has spread to the testis. This entry will chiefly address PTL.

What is Testicular Lymphoma?

Testicular lymphoma is a rare extranodal subtype of non-Hodgkin's lymphoma affecting the male testicles and is often pathologically diagnosed as an extranodal diffuse large B-cell lymphoma (DLBCL) of the testis. It is a rare cancer of the testis, amounting to less than ten percent of such cancers. The disease tends to have an aggressive clinical course, It is most often diagnosed in elderly men; however, an exception is in younger, male HIV positive patients, in whom PTL has a comparatively high incidence.

Symptoms and Diagnosis of Testicular Lymphoma

Most commonly, testicular lymphoma presents as a painless unilateral (one-sided) mass on the testis, although in about one-fifth of the cases, it is bilateral (affecting both testis). Self-testicular exams properly carried out can contribute to early detection.

Diagnosing testicular lymphoma will almost invariably require an orchidectomy (also spelled orchiectomy), which is the surgical removal of a testis (a procedure which keeps the scrotum and penis otherwise intact).

Prognosis and Treatment of Testicular Lymphoma

Treatment of testicular lymphoma generally involves some form of doxorubicin-based, systemic combination chemotherapy, such as R-CHOP. Another treatment is involved-field radiotherapy to the testis. In some cases, patients may receive both chemotherapy and radiation. The earlier the stage of the disease, the higher the success rate of treatment, although in the case of testicular lymphoma it appears that there is even a success rate difference between early stage disease (stage I and stage II).

When testicular lymphoma recurs following treatment, common sites include the central nervous system (CNS). For this reason, CNS prophylaxis (preventive medicine) could be necessary, in which case patients might receive intrathecal chemotherapy involving methotrexate, cytarabine and dexametasone.

Prognosis for most patients with testicular lymphoma is good, especially those diagnosed and treated for early-stage disease. However, later-stage disease is more difficult to treat and prognosis in these cases is considered rather poor.

Sources

• Shahab N et al. Testicular lymphoma. Semin Oncol.
• Fonseca R et al. Testicular lymphoma is associated with a high incidence of extranodal recurrence. Cancer.
• Hsiang JY et al. Early stage primary testicular lymphoma: Treatment and outcome—ASCO Proc Am Soc Clin Oncol 22: 2003 (abstr 2399)
• Al-Abbadi MA et al. Primary testicular diffuse large B-cell lymphoma belongs to the nongerminal center B-cell-like subgroup: a study of 18 cases. Modern Pathology 19, 1521-1527.
• Vural F et al. Primary Testicular Lymphoma. Jour Nat Med Assoc.

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