Primary testicular lymphoma: A case report highlighting 18 F-FDG PET/CT role

Primary testicular lymphoma (PTL) is a rare but aggressive form of non-Hodgkin lymphoma (NHL) that primarily affects older men. Diagnosis is challenging, and early detection is crucial for improving patient outcomes. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) plays a pivotal role in the diagnosis, staging and monitoring of primary testicular lymphoma, providing detailed metabolic and anatomical information that guide therapeutic strategies.

A 56-year-old male with no significant medical history presented persistent right testicular pain for 15 days. The initial ultrasound findings suggested presuppurative orchiepididymitis, which did not resolve with antibiotic therapy. Subsequent imaging revealed suspicious testicular architecture and inguinal lymphadenopathy. The right orchiectomy confirmed the diagnosis of diffuse large B-cell lymphoma. 18F-FDG PET/CT demonstrated widespread nodal involvement and possible bilateral testicular primary disease. The patient underwent chemotherapy with R-CHOP, but was lost to follow-up. His condition deteriorated and disease progression led to his death a few weeks later.

PTL typically presents as a painless scrotal mass with a high tendency for bilateral and systemic involvement. Staging and treatment include orchiectomy, chemotherapy, and sometimes radiation therapy, although there is no standardized protocol. 18F-FDG PET/CT significantly improves diagnostic accuracy, allowing for precise staging and evaluation of treatment response. However, PTL remains a highly aggressive disease with poor overall survival and frequent relapses, often affecting the central nervous system.

This case underscores the importance of early diagnosis and comprehensive management of PTL. 18F-FDG PET/CT serves as an invaluable tool in detecting primary and metastatic involvement, guiding treatment decisions, and monitoring disease progression. Further research is needed to optimize treatment strategies and improve patient outcomes.