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Pathology for Urologists

Lymphoma


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  • Comprise 5% of all testicular tumors.
  • May occur either as a primary or secondary (more common) spread to testis.
  • Most common testicular tumor in older men (>50 years old).
  • Bilateral involvement is common and most patients have systemic disease by the time they develop testicular involvement.
  • Presents with painless testicular mass, fever, night sweats or weight loss (B symptoms).
  • Gross: May diffusely replace testicular parenchyma and exhibits fleshy gray-white lobulated cut surface (looks like seminoma or spermatocytic seminoma) (image A).

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  • Most common is diffuse large B cell lymphoma, others MALT lymphoma, follicular lymphoma and T cell lymphomas; Burkitt's lymphoma in children.
  • Histology:
    • Sheets of malignant lymphoid cells, which infiltrate in between normal testicular structures (diffuse interstitial pattern most common) (image B), (image C), & (image D).
    • May also efface and infiltrate seminiferous tubules (intratubular growth).
    • "Onion-skin" pattern with reticulin stain.
    • Rare plasmacytoma reported.
  • Immunohistochemistry: CD45+, CD20+ (B cells), CD3+ (T cells) and CD138+ (plasmacytoma).
  • Prognosis is generally poor with a 5-year survival rate of 37-48%.

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