High grade non-germinal centre-like diffuse large B-cell lymphoma double expressor presenting as a hydrocoele

Area of Science:

• Urology
• Oncology
• Radiology

Background:

• Scrotal swelling can present diagnostic challenges, sometimes mimicking benign conditions like hydrocoele.
• Early and accurate diagnosis is crucial for effective management of testicular and paratesticular masses.

Observation:

• A 72-year-old man presented with left hemi-scrotal swelling, initially suspected as hydrocoele.
• Ultrasound revealed testicular enlargement and a mass extending into the inguinal canal.
• CT imaging demonstrated the mass extending along the gonadal vein to the renal vein.

Findings:

• Retroperitoneal mass biopsy confirmed diffuse large B-cell lymphoma, immunohistochemically classified as double expressor.
• The patient received a combination of steroids, chemotherapy, and scrotal radiotherapy due to the sanctuary site involvement.
• Successful treatment resulted in a good recovery and improved recurrence-free survival prognosis.

Implications:

• This case underscores the importance of advanced imaging in differentiating scrotal masses and avoiding misdiagnosis.
• Multidisciplinary team collaboration is vital for optimizing treatment strategies and patient outcomes in complex oncological cases.
• Early specialist referral and appropriate diagnostic workup are essential for managing rare presentations of lymphoma.