A 71-year-old male presented with non-irradiated right testicular pain of three months duration, with increased testicular diameter and consistency in the last month.
He has constitutional syndrome, with weight loss of 3 kg in the last month.
Fever in peaks up to 39oC, non-clinical mucus, non-hematuria sweating.
COPD with treatment with inhalers and chronic home oxygen stand out as a background of interest.
On physical examination, the patient is affected, with mucocutaneous stiffness, crackles on pulmonary auscultation, lower limb edema, non-adenopathy, hematomas in both upper limbs.
Genital examination in the right hemiscrotum shows edema of the cover, increased consistency of the epididymis and testis, with disappearance of the testicular epididymal groove, without signs of fluctuation or ab
Adenomatous prostate rectal examination grade II-III/IV.
Analytically stands out hemoglobin 8.1 gr/dl (previous of 13.5 gr/dl), platelets 51000, 9100 leukocytes.
Coagulation increased fibrinogen 1500 (normal range below 400).
High dehydrogen lactate (LDH), BHCG, CEA, AFP, normal renal, hepatic and pancreatic function.
Chest radiography, minimal vascular congestion, normal abdominal X-ray.
Renal and bladder ultrasound without alterations, prostate of 4.5 x 4 x 4.1 cm. Testicular ultrasound, normal left testicle, right testicle distinguishes up to three heterogeneous areas with decreased echogenicity, without inferior pole hydrocele.
1.
With the suspected diagnosis of testicular abscess versus testicular tuberculosis, brucellosis or testicular tumor, we performed radical inguinal orchiectomy.
The pathological anatomy reports, in the macroscopic examination of a testicle tumor of 8 x 6 x 4 cm, presenting a whitish mass of 5.5 cm at the cut, surpassing the hybular layer and epididymis but not.
Microscopically, the testicle is affected by diffuse large B-cell lymphoma, with a high proliferation index (minb1 > 80%), and CD 20+ markers.
Stage 1E-B.
1.
With the diagnosis of primary testicular lymphoma, we requested a whole-body staging CT, observing homogeneous thickening, isolated retroperitoneal lymphadenopathy less than 1 cm, as remarkable findings.
In the postoperative evolution, the patient presents profuse fever, asthenia, and lower limb edema.
Analytically, anemia 8.9 gr/dl of hemoglobin, platelets 37000, and normal leukocyte and lymphocyte formula persist.
With the diagnosis of B symptoms in a patient with primary testicular lymphoma, a bone marrow biopsy was performed, obtaining a cylinder of 3 x 0.3 cm, in which there is hypercellular bone marrow with regenerative and dysplastic changes.
Marked interstitial collagenosis is evident, with emphasis on lymphocytes.
1.
Since bone marrow failure was not detected, blood smear was performed to justify the cause of anemia and thrombocytopenia.
Platelet aggregation was observed, with direct Coombs test being weakly positive for immunoglobulin G, being the cause of aggregation.
During hospitalization, the patient developed dysphonia and dysphagia, performing fibroscopy, polypoid lesion in the pyriform sinus.
The cervical CT was normal.
During admission, the patient was prescribed Rituximab and the following day, the first cycle of CHOP fever (hallucinamide, doxorubicin, vincristine, prednisone), with intense improvement of symptoms B
Chemotherapy was started with 6 cycles of R-CHOP.
She received adjuvant genital radiotherapy and cerebral chemoprophylaxis.
At 12 months the patient is free of disease.
