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  Table of Contents    
CASE REPORT  
Year : 2011  |  Volume : 54  |  Issue : 3  |  Page : 588-590
Primary lymphoma of the spermatic cord: A case report and review of the literature


1 Department of Pathology, "G. Gennimatas", "Konstantopoulio" General Hospital, Nea Ionia, Athens, Greece
2 Department of Urology, "Konstantopoulio" General Hospital, Nea Ionia, Athens, Greece

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Date of Web Publication20-Sep-2011
 

   Abstract 

Primary lymphomas of the spermatic cord are extremely rare. To date, only 15 cases have been reported in the international literature. Herein, we report a new case of a primary lymphoma of the spermatic cord. A 73-year-old patient presented at the Urology Department, complaining of bilateral painful masses at the inguino-scrotal region. A computed tomography scan revealed spermatic cord tumor. A right inguinal orchidectomy was performed in order to establish a definitive diagnosis. Macroscopically, the tumor was restricted to the spermatic cord area, leaving unaffected the testis and the epididymis. The histopathological and immune-histological evaluation has indicated a diffuse large B-cell lymphoma. Postoperatively, the patient was investigated thoroughly but no further signs of the disease were found.

Keywords: Non-Hodgkin lymphoma, primary paratesticular lymphoma, spermatic cord tumor

How to cite this article:
Diakatou E, Haramis G, Kostopoulou A, Kakiopoulos G. Primary lymphoma of the spermatic cord: A case report and review of the literature. Indian J Pathol Microbiol 2011;54:588-90

How to cite this URL:
Diakatou E, Haramis G, Kostopoulou A, Kakiopoulos G. Primary lymphoma of the spermatic cord: A case report and review of the literature. Indian J Pathol Microbiol [serial online] 2011 [cited 2020 Nov 23];54:588-90. Available from: https://www.ijpmonline.org/text.asp?2011/54/3/588/85103



   Introduction Top


Non-Hodgkin lymphoma is a malignancy that may occur in every part of the body. Malignant lymphoma of the testis constitutes 2% of all testicular neoplasms and 5% of all extranodal lymphomas in men. The majority of paratesticular lymphomas present in connection with testicular lymphomas. Primary paratesticular lymphomas and, more specifically, primary lymphomas of the spermatic cord are extremely rare. [1],[2] Only 15 cases have been reported in the international literature. The purpose of this article is to present a new case of primary lymphoma of the spermatic cord and to review the literature until today. Additionally, because there are cases frequently misdiagnosed as inguino-scrotal hernias, it is of great importance for the physician to be aware of this unique clinical entity.


   Case Report Top


A 73-year-old patient presented at the Urology Department with complaints of bilateral painful palpable masses in the inguino-scrotal area. At the physical examination, no other signs of disease were found. The laboratory tests were normal. The abdominal computed tomography (CT) scan revealed bilateral masses in the area of the spermatic cords [Figure 1]. A right inguinal orchidectomy was performed in order to establish a definitive diagnosis.
Figure 1: The computed tomography scan revealed bilateral masses at the inguino-scrotal area

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Macroscopically, the specimen consisted of a testis measuring 5.5cm Χ 5cm Χ 4cm and the ipsilateral spermatic cord was 8.5 cm long. The cut-surface of the spermatic cord in a 5-cm area was grayish-white, solid, with rubbery consistency while the normal anatomical structures were not distinguishable. The cut-surface of the testis revealed no signs of macroscopical infiltration. On microscopic examination, the spermatic cord nodule consisted of lymphoid large cells with clear or slightly eosinophilic cytoplasm with large, strongly atypical, polymorphic nuclei and a great number of mitoses [Figure 2] and [Figure 3]. The testis parenchyma, the rete testis and the epididymis appeared unaffected. The immunohistochemical evaluation showed a strong positivity against CD20 and CD79a [Figure 4], positivity for bcl 2 and bcl 6 antigens and a weak positivty for CD5. The ki-67 proliferation labeling index (LI) was estimated to be near 90%. The immunostaining against CD10, CD30, Cyclin D1, ALK, PLAP, a-FP, pankeratin, β hCG and EMA were negative. Some small, reactive T lymphocytes were positive against CD3, CD5 and bcl2. The diagnosis was that of a diffuse, large B non-Hodgkin lymphoma. Postoperatively, the patient was extensively investigated but no further signs of the disease were found. The CT scan of the upper abdomen revealed no enlarged lymph nodes; the liver and spleen appeared normal and the bone marrow biopsy was interpreted normal as well. After that, we concluded that we were dealing with a primary lymphoma of the spermatic cord. The patient received chemotherapy (CHOP-Cyclophosphamide, Adriamycin, Vincristine and Prednisone) and he is in a good condition for the last 6 months.
Figure 2: Adjacent to the spermatic cord and the vessel, a nodule is seen as a compact nodule consisting of large, atypical and polymorphic lymphoid cells (hematoxylin and eosin, x25)

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Figure 3: High-power magnification of the lesion showing atypical lymphoid cells (hematoxylin and eosin, x200)

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Figure 4: CD79-a B lymphoid marker positivity (immunohistochemistry, x400)

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   Discussion Top


Primary lymphoma of the spermatic cord is an extremely rare disease. [1],[2],[3] Only 15 cases have been reported in the current literature until now. It is estimated that primary spermatic cord lymphomas do not exceed 1.5-2% of all tumors of the spermatic cord. [4] Prior reports have indicated that lymphoma is the most common bilateral testicular tumor. [5],[6] It affects mostly middle-aged individuals with a mean age of 56 years. [7] Most patients report painless palpable masses in the inguino-scrotal area, while some of them may complain of painful masses as well. [8] Typically, there are no clinical symptoms such as weight loss, fever or night sweating. [9] Occasionally, they might be falsely interpreted as hernias, which underlines the importance for a urologist to be aware of this entity. [7],[10] Macroscopically, the cut-surface reveals a poorly demarcated grayish nodule, with or without necrosis and hemorrhage. Radiologically, it appears as a diffuse infiltration of the region, while at the ultrasound examination, the masses will be hypoechoic. Histologically, 80% of the primary lymphomas of the spermatic cord are non-Hodgkin, diffuse, large B-cell lymphomas. [10] The primary lymphomas of the testis and spermatic cord have the worst prognosis among all extranodal lymphomas, with the 5-year overall survival ranging between 70 and 79%. [10] Favorable factors are lymphoma sclerosis, young age and early stage. Therapy of choice is surgical excision and chemotherapy (CHOP), followed by radiotherapy.

 
   References Top

1.Henley JD, Ferry J, Ulbright TM. Miscellaneous rare paratesticular tumors. Semin Diagn Pathol 2000;17:319-39.  Back to cited text no. 1
[PUBMED]    
2.Vega F, Medeiros LJ, Abruzzo LV. Primary paratesticular lymphoma: A report of 2 cases and review of the literature. Arch Pathol Lab Med 2001;125:428-32.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Okabea M, Kurosawa M, Suzuki S, Kondo T, Choi GH, Hatanaka K, et al . Primary lymphoma of spermatic cord. Leuk Lymphoma 2001;40:663-6.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.El-Badawi AA, Al -Ghorab MM. Tumours of the spermatic cord: A review of the literature and a report of a case of lymphangioma. J Urol 1965;94:445-50.  Back to cited text no. 4
    
5.Bach DW, Weissbach L, Hartlapp LH. Bilateral testicular tumour. J Urol 1983;129:989-91.  Back to cited text no. 5
    
6.Ferry JA, Harris NL, Young RH, Coen J, Zietman A, Scully RE. Malignant lymphoma of the testis, epididymis, and spermatic cord. A clinicopathologic study of 69 cases with immunophenotypic analysis. Am J Surg Pathol 1994;18:376-90.  Back to cited text no. 6
[PUBMED]    
7.Michael B Moller Non Hodgkin's lymphoma of the spermatic cord. Acta Haematol 1994;91:70-2.  Back to cited text no. 7
    
8.Hautzer NW, Nikolai V. Primary Lymphoma of the Spermatic cord. Br J Urol 1986;58:565-6.  Back to cited text no. 8
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9.Lagrange JL, Ramaioli A, Theodore CH, Terrier-Lacombe MJ, Beckendorf V, Biron P, et al . Non-Hodgkin's lymphoma of the testis A retrospective study of 84 patients Ann Oncol 2001;12:1313-9.  Back to cited text no. 9
    
10.D'Abrosca F, Lucev M, Turi V, Gerosa E, Villani L. Primary lymphoma of the spermatic cord. Minerva Chir 1990;45:531-3.  Back to cited text no. 10
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Correspondence Address:
Evanthia Diakatou
Department of Pathology, "G. Gennimatas" Athens General Hospital, 154 Mesogeion Av. 11527 Athens
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.85103

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

This article has been cited by
1 Lymphoma of the spermatic cord: Sonographic appearance
Michele Bertolotto,Antonio Borsato,Lorenzo E. Derchi
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[Pubmed] | [DOI]



 

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