Testicular lymphoma

Diffuse large cell B-cell lymphoma is an aggressive extranodal non-Hodgkin’s lymphoma.

Accounts for approximately 5% of all testicle tumors.

Accounts are one and 2% of non-Hodgkin lymphomas.

It is the second most common type of testicle cancer.

Testicular lymphoma is more common than primary testicle cancers in an older than 50 years and may account for 20-50% of all testicular neoplasms.

Prognosis is dependent on stage of the disease.

Patients usually present with a large testicle mass.

Most patients present with localized stage I IIE disease.

Lesions it may be bilateral.

May be associated with trauma, family history or testicle descent problems, although the relationships are questionable.

Most cases are diffuse histiocytic or diffuse poorly differentiated lymphocytic type.

Patients are at increased risk for a CNS or leptomeningeal spread and CNS prophylaxis is suggested management.

Distal relapse at extranodal sites, especially the central nervous system and the contralateral testicle or common.

Treatment includes surgical removal followed by radiation and/or chemotherapy.

Because of high likelihood of systemic relapse chemotherapy is usually recommended, even in the presence of early stage disease.

Recent studies employing systemic chemotherapy, intrathecal chemotherapy, scrotal and lymphatic radiation demonstrated a 5 year overall survival of greater than 80% (Murthy V et al).

International Extranodal Lymphoma Study Group demonstrated 80 median survival of 4.8 years and 5 and 10 year overall survival rates of 48% and 27%, respectively, with the majority of the tumors being stage I.

Studies reveal median overall survival of 4-5 years, with a continual risk of relapse in disease related deaths, even 10 years after diagnosis.

R-CHOP therapy is standard treatment, plus intrathecal therapy followed by local regional radiation.

CNS prophylaxis and contralateral testicular radiation should be considered to prevent relapse.

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