Case report
Testis-Isolated Mantle Cell Lymphoma: A Unique Case

https://doi.org/10.1016/j.clml.2011.06.013Get rights and content

Introduction

Approximately 1%-2% of all lymphoma cases are primary testicular lymphoma.1 Testicular lymphoma usually arises in older men, and the histiologic subtype is most often diffuse large B-cell lymphoma (DLBCL). Other histologies, for example, mantle cell lymphoma, are very rare. A relatively large series from Massachusetts General Hospital was published in 1994 that describes 69 cases of malignant lymphoma of the testis, epididymis, and spermatic cord.2 There was only 1 tumor consistent with the currently recognized entity of mantle cell lymphoma (described as centrocytic lymphoma histology Kiel subtype, diffuse small cleaved cell histology by Working Formulation). In a recently published series of 18 primary testicular lymphomas diagnosed over a 2-year period at an Austrian center, all were DLBCL except for 1 lymphoma, not otherwise specified (sparse biopsy material available), and 2 mantle cell lymphomas, pleomorphic subtype.3 The lymphoma group at MD Anderson Cancer Center identified 1 case of mantle cell lymphoma with testicular involvement in more than 300 testicular lymphoma cases seen over a decade at that institution.4 All 4 of the above testicular mantle cell lymphomas were at advanced stage.

At our center, we recently evaluated a patient with mantle cell lymphoma localized to the testis. We systematically surveyed our institutional experience with mantle cell lymphoma, searching for any other patients with testis involvement. Of 897 patients with mantle cell lymphoma, we found 1 additional patient case with (bilateral) testicular involvement.

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Methods and Patients

We queried the Memorial Sloan-Kettering Cancer Center (MSKCC) Institutional Database Web-based data search engine (DAVInCI) to determine the number of patients diagnosis coded for mantle cell lymphoma. DAVInCI is an MSKCC Web-based application that enables independently run data queries. DAVInCI data are updated daily and consist of demographics, diagnosis and procedure codes, pathology reports, hospital and outpatient encounters, dispensed medications, and laboratory results.

This search

Case Report

An 80-year-old man with a history of coronary artery disease and prostate cancer status post brachytherapy with no evidence of disease presented to us for an opinion after having recently undergone a left orchiectomy that showed mantle cell lymphoma, stage IEA, pending completion of staging with bone marrow examination The patient originally palpated a firm left testes lesion, and this led to an ultrasound, which revealed an enlarged left testis with hypoechoic shadowing relative to the right

Discussion

Our institutional experience of more than 800 cases of mantle cell lymphoma, of which 2 involved the testis, confirms the true rarity of mantle cell primary testicular lymphoma, which usually presents at advanced stage. To our knowledge, this is the first reported case of mantle cell lymphoma localized to the testis.

Cases in the medical literature, as well as our patient, are of mantle cell lymphoma presenting as a pleomorphic variant. For instance, our patient's tumor was CD10+, an unusual

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