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Penile diffuse large B-cell lymphoma in a young man
Ian Robertson1, Jon Heald2, Daniel Ding3
1Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA ianrobertson415@gmail.com.
Insights
This case study details a rare instance of penile diffuse large B-cell lymphoma (DLBCL) in a young adult. The patient successfully responded to R-CHOP chemotherapy, avoiding radiation therapy.
Area of Science:
- Hematology
- Oncology
- Urology
Background:
- Penile diffuse large B-cell lymphoma (DLBCL) is an exceptionally rare extranodal non-Hodgkin lymphoma.
- Primary penile DLBCL typically affects elderly men, with a median age of 69 years.
Purpose of the Study:
- To report a unique case of stage IE penile DLBCL in a young active-duty service member.
- To discuss the diagnosis and management of this rare condition in an atypical demographic.
Main Methods:
- Case presentation of a young male diagnosed with stage IE penile DLBCL, germinal centre B-cell (GCB) subtype.
- Treatment administered included four cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP).
- Interim positron emission tomography (PET) scan guided the decision to omit radiation therapy.
Main Results:
- The patient, significantly younger than the typical demographic, achieved a positive response to R-CHOP chemotherapy.
- Radiation therapy was not administered due to the favorable PET scan results, indicating treatment efficacy.
- The case highlights successful management of penile DLBCL in an unusual patient profile.
Conclusions:
- Penile DLBCL, though rare, can occur in younger individuals, challenging typical epidemiological patterns.
- R-CHOP chemotherapy is an effective treatment option for limited-stage penile DLBCL.
- PET-guided treatment de-escalation may be feasible in select cases of penile DLBCL, sparing patients from radiation toxicity.
Abstract:
Here, we present the case of a young man active-duty service member diagnosed with stage IE penile diffuse large B-cell lymphoma (DLBCL), germinal centre B-cell (GCB) subtype. Primary penile DLBCL is an exceptionally rare condition, with fewer than 30 cases reported in the medical literature. Notably, this patient is significantly younger than the typical demographic, as extranodal DLBCL affecting the penis usually occurs in elderly men, with a median age of 69 years at diagnosis. The treatment for limited-stage DLBCL generally depends on patient-specific risk factors and often involves a limited number of chemotherapy cycles, with or without localised radiation. Our patient received four cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). In this case, we chose to forgo radiation therapy due to the positive response observed on the interim positron emission tomography scan. This case not only highlights the unusual occurrence of DLBCL in a young patient and at an uncommon site but also contributes valuable insights into the diagnosis and management of this rare lymphoma subtype.
