SHM Converge Scientific Abstract ePoster Gallery-A Diagnostic Dilemma: Primary Testicular Lymphoma Masquerading as Refractory Epididymitis

Pdf Summary

This case describes a 79-year-old man with progressive right testicular pain and swelling initially diagnosed as epididymitis. Despite two courses of antibiotics and repeat ultrasound studies suggesting persistent epididymitis/orchitis, his symptoms worsened. A CT abdomen/pelvis then revealed widespread metastatic-appearing disease, including tumor extension through the right gonadal vein, inguinal canal/scrotum, and infrarenal IVC, with additional masses in the prostate, adrenal glands, liver, lymph nodes, and lung bases.  <br /><br />Further workup showed markedly elevated LDH and low testosterone, while other labs were largely unrevealing. PET/CT demonstrated intense FDG uptake in the right testicle, suggesting it as the primary malignancy site. A CT-guided biopsy of retroperitoneal lymphadenopathy confirmed diffuse large B-cell lymphoma (DLBCL), non-germinal center type, with no MYC, BCL2, or BCL6 rearrangements by FISH. Brain MRI did not show clear malignancy, and lumbar puncture was negative for CNS involvement.  <br /><br />The final diagnosis was primary testicular lymphoma, a rare and aggressive extranodal lymphoma that accounts for less than 5% of testicular malignancies and 1–2% of NHL cases. It most commonly affects men in their sixth decade and is associated with a higher risk of CNS spread. The patient was treated with port placement, R-CHOP chemotherapy, and intrathecal methotrexate for CNS prophylaxis.  <br /><br />This case emphasizes the importance of considering primary testicular lymphoma in older men with persistent scrotal pain and swelling, especially when symptoms do not improve with standard treatment for infection, to avoid delayed diagnosis and treatment.

Asset Subtitle

Caroline Horne

Meta Tag

Author List Caroline Horne

Category Clinical Vignettes

Concept Primary Testicular Lymphoma

Concept Diffuse Large B-Cell Lymphoma

Concept Extranodal Lymphoma

Concept Biopsy

Concept Pathology

Distinguished Non-Finalist

Presenter Organization Atrium Health Carolinas Medical Center

Presenting Author Caroline Horne

Track Adult

Keywords

primary testicular lymphoma

diffuse large B-cell lymphoma

testicular pain

scrotal swelling

epididymitis mimic

metastatic disease

PET/CT

R-CHOP chemotherapy

CNS prophylaxis

older men

Primary Testicular Lymphoma

Diffuse Large B-Cell Lymphoma

Extranodal Lymphoma

Biopsy

Pathology