(Figs. 1 and 2)
(Figs. 3a and b)
(Figs. 1 and 2)
(Figs. 3a and b)
Click on Images for Enlarged View
Findings: There is marked enlargement of the right testicle (Fig 1). There is diffusely decreased echogenicity of the right testicle compared to the left (Fig 2). Doppler examination shows diffusely increased flow within the right testicle. (Fig. 3).
Diagnosis: Testicular lymphoma.
Discussion: Testicular lymphoma constitutes 1-7% of all testicular tumors, and is the most common tumor in males between the ages of 60-80. While it is seen as the presentation of non-Hodgkins lymphoma in 1% of patients, it more commonly represents a site of relapse in patients with the pre-existing diagnosis of lymphoma. The testicle is felt to be a 'sanctuary' from chemotherapeutic agents, and is therefore a common place of extranodal relapse of the lymphomas and leukemias.
Pathologically, there is diffuse, symmetric involvement of the testis. The tumor is infiltrative, and tends to compress but not invade the seminiferous tubules of the testicle. Radiographically, the ultrasound appearance mimics the pathology, with diffuse enlargement and infiltration of the testis. Involvement of the epidydymis is common. The ultrasound findings usually show focal or diffusely decreased echogenicity within the testicle. Doppler ultrasound shows diffuse increased flow within the mass. The differential diagnosis includes seminoma, leukemia, and orchitis. As in this case, the absence of pain or fever will favor the diagnosis of lymphoma, especially in an older patient.
References:
1. Moorjani V, Mashanka A, et al. AJR 157:1225-1226 1991.
2. Mazzu D,Jeffrey RB, Ralls PW. AJR 1995:164:645.
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