Malignant lymphoma of the testis

Five patients with primary non-Hodgkin's lymphoma of the testis were studied. The lymphomas had an intermediate grade of malignancy according to the Working Formulation. One patient was in clinical stage IEA, 3 in clinical stage IIEA and one in clinical stage IVB. Central nervous system (CNS) infiltration occurred in 3 patients. The survival was very poor and ranged from 9 days to 5 1/2 years after diagnosis, median 7 1/2 months. In order to improve prognosis aggressive (3 or more cytostatics) chemotherapy is recommended to follow orchidectomy and staging. As for other lymphomas of intermediate- and high-grade malignancy, a more effective systemic therapy is needed for the younger patients, but in the elderly (greater than 70 years) the regimen and the dose intensity have to be adapted to their tolerance. Prophylactic radiation of the opposite uninvolved testis is not recommended, but frequent scrotal ultrasonography during the first 2 years after diagnosis appears essential. Prophylactic intrathecal chemotherapy means an overtreatment for patients in clinical stages I and II, but is indicated in relapsing patients and in clinical stages III and IV.