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case_images: Imaging features of the patient's lymphoma. (A) Ultrasonography demonstrates a focal area of hypoechogenicity with hypervascularity in the left testis. (B and C) Post-orchiectomy PET/CT shows an FDG-avid lesion (green arrow) in the right testis. (D) PET/CT-based CR was achieved after first-line immunochemotherapy. (E and F) At the first follow-up examination, MRI horizontal and frontal views show a new lesion (red arrow) involving right basal ganglia and pons. (G and H) MRI horizontal and frontal views show that the new lesion disappeared after the first cycle of chemo-free treatment.
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case_images: Ultrasound examination showed a low-density mass in his left testis with abundant blood supply (Figure 1A). BCL-2, BCL-6, and MYC gene rearrangements using FISH were all negative (Supplementary materials Figure S1). PET/CT showed an FDG-avid lesion in the right testis with SUVmax of 11.4, which was considered to be lymphoma involvement (Figure 1B and C). A complete response (CR) evaluated by PET/CT was achieved at the end of immunochemotherapy (Figure 1D). Physical and laboratory examinations found no abnormalities, but head MRI showed a new lesion involving his right basal ganglia and pons, which was considered as a CNS relapse secondary to PTL (Figure 1E and F). After the first cycle of treatment, repeated head MRI showed that the intracranial lesion disappeared (Figure 1G and H), indicating that a CR was achieved.
case_images: Immunohistochemical features of the patient's tumor. The lymphoma cells were positive for CD20, CD79a, Mum-1 (dim), BCL-6, BCL-2, and C-MYC, and negative for CD10. Ki-67 proliferation index was about 90%. Original manifestation 400x.
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case_images: BCL-6, MUM-1 (dim), and C-MYC, and negative for CD10. BCL-2 was expressed in 90% of tumor cells and Ki-67 was positive in 90% of cells (Figure 2).
case_images: Treatment timelines of the patient.
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case_images: The treatment timelines are shown in Figure 3.