Primary malignant lymphoma of the testis

Primary testicular lymphomas are rare entities representing 1-2% of non-Hodgkin lymphoma (NHML) and 1-7% of malignant testicular tumors and they are the most common testicular tumors in men older than 50 years of age. This study included 8 cases of inpatients diagnosed by echography and NMR with testicular tumors. The age of patients was between 46 and 81 (with a mean of 52). The tumors were unilateral, with disease limited to testicle and accompanied by pain except 1 case with bone involvement. Orchectomy was performed as first therapeutic and diagnostic purpose. All patients were clinically staged according to the Ann Arbor criteria in IE and IIID stage and received a doxorubicin based chemotherapy regimen (CHOP, MTX, CVP, and Leukeran). A standard chemotherapy protocol has not been used because of reduced number of patients. Tumor fragments were fixed in 10% formallin, paraffin embedded, sectioned and standard H.E. stained. Immunohistochemistry for L26, Alphafetoprotein, NK1, CD30, and CLA was performed. Microscopy revealed in all cases a stromal proliferation with medium size cells, monomorphic shape and prominent nucleoli. Alphafetoprotein was positive in seminal tubes and negative in tumor, NK1 in small lymphocyte and negative in tumor and L26 diffuse positive in tumor. CLA diffuse positive in tumor. We were able to follow up only four patients.

The diagnosis was of NHML in 6 cases and for 2 secondary involvement of hematopoietic malignancy (myeloid sarcoma and leukemia). Lymphoma cases were typed using REAL classification as small and large B-cell lymphoma. Unfavorable evolution with 6 months relapse and one death prove a more aggressive evolution of primitive testicular lymphoma.