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Lymphoma of the testis as primary location: tumour review

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  • Molecular and Cellular Biology of Cancer
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Abstract

Non-Hodgkin’s lymphoma as a primary testicular neoplasm accounts approximately 9% of all testicular malignant tumours and about 1–2% of all non-Hodgkin’s lymphoma. This neoplasm is the most common malignant tumour of the testis in the elderly. The most common histotype in primary forms is the diffuse large B-cell lymphoma, whereas more aggressive histologies such as Burkitt’s lymphoma are principal founded in cases of secondary involvement of the testis. Regarding clinical presentation, the most common sign is a unilateral painless scrotal swelling, sometimes with sharp scrotal pain or hydrocele. In patients with advanced stage, the systematic B symptoms are present in 25–41% of all cases. In 35% of patients, bilateral testicular involvement is detected. In more advanced stages with para-aortic lymph-node involvement, ascites and abdominal pain is evident. Despite the fact that responses to doxorubicin-containing chemotherapy, especially in early stages, show good results, relapses are often seen, and the prognosis of this tumour is very poor. Testicular lymphoma often disseminates to other extranodal organs, such as contralateral testis, central nervous system (CNS), lung, pleura, Waldeyer’s ring and soft tissue. For patients with limited disease, the recommended first-line treatment is orchiectomy followed by rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) combination chemotherapy, with central nervous system (CNS) prophylaxis and prophylactic irradiation of the contralateral testis. In more advanced or relapsed disease, management should follow the worldwide recommendations for nodal diffuse large B-cell lymphoma (DLBCL). Here we present a review of this tumour.

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References

  1. Duncan PR, Checa F, Gowing NF et al (1980) Extranodal non-Hodgkin’s lymphoma presenting in the testicle: a clinical and pathologic study of 24 cases. Cancer 45:1578–1584

    Article  CAS  PubMed  Google Scholar 

  2. Zucca E, Roggero E, Bertoni F, Cavalli F (1997) Primary extranodal non-Hodgkin’s lymphomas. Part 1. Gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol 8:727–737

    Article  CAS  PubMed  Google Scholar 

  3. Tondini C, Ferreri AJ, Siracusano L et al (1999) Diffuse large-cell lymphoma of the testis. J Clin Oncol 17:2854–2858

    CAS  PubMed  Google Scholar 

  4. Osman R, Morrow JW (1969) Reticulum cell sarcoma with primary manifestation in the testicle: three case reports. J Urol 102:230–232

    CAS  PubMed  Google Scholar 

  5. Sussman EB, Hajdu SI, Lieberman PH, Whitmore WF (1977) Malignant lymphoma of the testis: a clinicopathologic study of 37 cases. J Urol 118: 1004–1007

    CAS  PubMed  Google Scholar 

  6. Talerman A (1977) Primary malignant lymphoma of the testis. J Urol 118:783–786

    CAS  PubMed  Google Scholar 

  7. Doll DC, Weiss RB (1986) Malignant lymphoma of the testis. Am J Med 81:515–524

    Article  CAS  PubMed  Google Scholar 

  8. Moller MB, d’Amore F, Christensen BE (1994) Testicular lymphoma: a population-based study of incidence, clinicopathological correlations and prognosis. The Danish Lymphoma Study Group, LYFO. Eur J Cancer 30A:1760–1764

    Article  CAS  PubMed  Google Scholar 

  9. Shahab N, Doll DC (1999) Testicular lymphoma. Semin Oncol 26:259–269

    CAS  PubMed  Google Scholar 

  10. Sampat MB, Sirsat MV, Kamat MR (1974) Malignant lymphoma of the testis in Indians. Br J Urol 46:569–575

    Article  CAS  PubMed  Google Scholar 

  11. Ahmad M, Khan AH, Mansoor A et al (1991) Non-Hodgkin’s lymphomas with primary manifestation in gonads—a clinicopathological study. J Pak Med Assoc 44:86–88

    Google Scholar 

  12. Poulsen MG, Roberts SJ, Taylor K (1991) Testicular lymphoma—the need for a new approach. Australas Radiol 35:257–260

    Article  CAS  PubMed  Google Scholar 

  13. Hegde U, Filie A, Little RF et al (2005) High incidence of occult leptomeningeal disease detected by flow cytometry in newly diagnosed aggressive B-cell lymphomas at risk for central nervous system involvement: the role of flow cytometry versus cytology. Blood 105:496–502

    Article  CAS  PubMed  Google Scholar 

  14. Spaepen K, Stroobants S, Dupont P et al (2001) Prognostic value of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose ([18F]FDG) after first-line chemotherapy in non-Hodgkin’s lymphoma: is [18F]FDG-PET a valid alternative to conventional diagnostic methods? J Clin Oncol 19:414–419

    CAS  PubMed  Google Scholar 

  15. Carbone PP, Kaplan HS, Musshoff K et al (1971) Report of the committee on Hodgkin’s disease staging classification. Cancer Res 31: 1860–1861

    CAS  PubMed  Google Scholar 

  16. Zucca E, Conconi A, Mughal TI et al (2003) Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group. J Clin Oncol 21:20–27

    Article  CAS  PubMed  Google Scholar 

  17. Salem YH, Miller HC (1994) Lymphoma of genitourinary tract. J Urol 151:1162–11 70

    CAS  PubMed  Google Scholar 

  18. Ferry JA, Harris NL, Young RH et al (1994) Malignant lymphoma of the testis, epididymis, and spermatic cord. A clinicopathologic study of 69 cases with immunophenotypic analysis. Am J Surg Pathol 18:376–390

    Article  CAS  PubMed  Google Scholar 

  19. Lambrechts AC, Looijenga LH, van’t Veer MB et al (1995) Lymphomas with testicular localisation show a consistent BCL-2 expression without a translocation (14;18): a molecular and immunohistochemical study. Br J Cancer 71:73–77

    CAS  PubMed  Google Scholar 

  20. Moertel CL, Watterson J, McCormick SR, Simonton SC (1995) Follicular large cell lymphoma of the testis in a child. Cancer 75:1182–1186

    Article  CAS  PubMed  Google Scholar 

  21. Leite KR, Garicochea B, Srougi M et al (2000) Monoclonality of asynchronous bilateral lymphoma of the testis. Eur Urol 38:774–777

    Article  CAS  PubMed  Google Scholar 

  22. Crellin AM, Hudson BV, Bennett MH (1993) Non-Hodgkin’s lymphoma of the testis. Radiother Oncol 27:99–106

    Article  CAS  PubMed  Google Scholar 

  23. Fickers MM, Koudstaal J, van deWeijer FP, Verschueren TA (1991) Malignant lymphoma of the testis. Neth J Med 39:92–100

    CAS  PubMed  Google Scholar 

  24. Liang R, Chiu E, Loke SL (1990) An analysis of 12 cases of non-Hodgkin’s lymphomas involving the testis. Ann Oncol 1:383

    CAS  PubMed  Google Scholar 

  25. Ikeda Y, Nakazawa S, Kudo M (1986) Intracranial malignant lymphoma developing 20 years after total removal of testicular malignant lymphoma—case report. Neurol Med Chir (Tokyo) 26:68–70

    Article  CAS  Google Scholar 

  26. Zietman AL, Coen JJ, Ferry JA et al (1996) The management and outcome of stage IAE non-Hodgkin’s lymphoma of the testis. J Urol 155: 943–946

    Article  CAS  PubMed  Google Scholar 

  27. Fonseca R, Habermann TM, Colgan JP et al (2000) Testicular lymphoma is associated with a high incidence of extranodal recurrence. Cancer 88:154–161

    Article  CAS  PubMed  Google Scholar 

  28. Touroutoglou N, Dimopoulos MA, Younes A et al (1995) Testicular lymphoma: late relapses and poor outcome despite doxorubicin-based therapy. J Clin Oncol 13:1361–1367

    CAS  PubMed  Google Scholar 

  29. Ostronoff M, Soussain C, Zambon E et al (1995) Localized stage non-Hodgkin’s lymphoma of the testis: a retrospective study of 16 cases. Nouv Rev Fr Hematol 37:267–272

    CAS  PubMed  Google Scholar 

  30. Ciatto S, Cionini L (1979) Malignant lymphoma of the testis. Acta Radiol Oncol Radiat Phys Biol 18:572–576

    CAS  PubMed  Google Scholar 

  31. Connors JM (1998) Problems in lymphoma management: special sites of presentation. Oncology 12:185–191

    CAS  PubMed  Google Scholar 

  32. Linassier C, Desablens B, Lefrancq T et al (2002) Stage-I and -IIE primary non-Hodgkin’s lymphoma of the testis: results of a prospective trial by the GOELAMS Study Group. Clin Lymphoma:167–172

  33. Vitolo U, Zucca E, Martelli M et al (2006) Primary diffused large B-cell lymphoma of the testis (PTL): a prospective study of rituximab (R)-CHOP with CNS and contralateral testis prophylaxis. Results of the IELSG 10 study. Blood 108:65a

    Google Scholar 

  34. Sarris AH, Vitolo U, Zucca E et al (2006) Prospective management of primary testicular lymphoma (PTL) with doxorubicin-based chemotherapy, prophylactic intrathecal (IT) methotrexate and radiotherapy (RT), but without rituximab: results from IELSG. Blood 108 [abstract 2454]

  35. Feugier P, Virion JM, Tilly H et al (2004) Incidence and risk factors for central nervous system occurrence in elderly patients with diffuse large-B-cell lymphoma: influence of rituximab. Ann Oncol 15:129–133

    Article  CAS  PubMed  Google Scholar 

  36. Pectasides D, Economopoulos T, Kouvatseas G et al (2000) Anthracycline based chemotherapy of primary non-Hodgkin’s lymphoma of the testis: the Hellenic Cooperative Oncology Group experience. Oncology 58:286–292

    Article  CAS  PubMed  Google Scholar 

  37. Seymour JF, Solomon B, Wolf MM et al (2001) Primary large-cell non-Hodgkin’s lymphoma of the testis: a retrospective analysis of patterns of failure and prognostic factors. Clin Lymphoma 2: 109–115

    Article  CAS  PubMed  Google Scholar 

  38. Shenkier TN, Voss N, Fairey R et al (2002) Brief chemotherapy and involved-region irradiation for limited-stage diffuse large-cell lymphoma: An 18-year experience from the British Columbia Cancer Agency. J Clin Oncol 20:197–204

    Article  CAS  PubMed  Google Scholar 

  39. Zouhair A, Weber D, Belkacemi Y et al (2002) Outcome and patterns of failure in testicular lymphoma: A multi center rare cancer network study. Int J Radiat Oncol Biol Phys 52:652–656

    Article  PubMed  Google Scholar 

  40. Hasselblom S, Ridell B, Wedel H et al (2004) Testicular lymphoma—a retrospective, populationbased, clinical and immunohistochemical study. Acta Oncol 43:758–765

    Article  PubMed  Google Scholar 

  41. Visco C, Medeiros LJ, Mesina OM et al (2001) Non-Hodgkin’s lymphoma affecting the testis: is it curable with doxorubicin-based therapy? Clin Lymphoma 2:40–46

    Article  CAS  PubMed  Google Scholar 

  42. Connors JM (1998) Problems in lymphoma management: special sites of presentation. Oncology 12:185–191; discussion 192–195

    CAS  PubMed  Google Scholar 

  43. Darby S, Hancock BW (2005) Localised non-Hodgkin lymphoma of the testis: The Sheffield Lymphoma Group experience. Int J Oncol 26: 1093–1099

    PubMed  Google Scholar 

  44. Sehn LH, Donaldson J, Chhanabhai M et al (2005) Introduction of combined CHOP plus rituximab taxane dramatically improved outcome of diffuse large B-cell lymphoma in British Columbia. J Clin Oncol 23:5027–5033

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Georgios Koukourakis.

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Koukourakis, G., Kouloulias, V. Lymphoma of the testis as primary location: tumour review. Clin Transl Oncol 12, 321–325 (2010). https://doi.org/10.1007/s12094-010-0513-9

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