Primary testicular lymphoma with rupture: An unusual presentation
A 50-year-old male presented with a right side testicular swelling and right side inguinal lymph node enlargement since five months. Fine needle aspiration cytology of the inguinal lymph node showed cells having anisokaryosis, round vesicular nucleus, irregular nuclear border/nuclear clefts with scant cytoplasm. A diagnosis of NHL/metastatic deposits from testis was suggested.\nWe received the orchiectomy specimen measuring 8 × 6 × 5 cm. External surface showed a raw area/breach in capsule measuring 6 × 5 cm. Cut section showed a well-circumscribed grey-white tumor measuring 6 × 3 cm with focal areas of hemorrhage []. Periphery of the tumor showed normal compressed testicular tissue. Spermatic cord measured 9 × 2 cm. Cut section was unremarkable.\nMicroscopy showed a small round monotonous population of cells showing isokaryosis and scanty cytoplasm, arranged in sheets [Figures and ]. The stroma in between showed scanty fibrovascular tissue. Amidst the tumor tissue were seen a few eosinophils. Areas of confluent necrosis were also seen. Differential diagnoses of seminoma and NHL were offered. Immunohistochemistry showed that the tumor cells were positive for CD 20 [], and negative for CD 5, CD23 and Cyclin D1. Mib 1 proliferation index was 90%. There was immunoexpression for both kappa and lamda light chain. A final diagnosis of high-grade NHL of B-cell phenotype was considered.\nThe patient was then subjected to chest X-ray, ultrasound, CT scan, bone marrow and cerebrospinal fluid examination to look for involvement of the CNS, other lymph nodes and organs by NHL. There was no evidence of NHL elsewhere in the abdomen. The HIV status of the patient was negative. Hence a final diagnosis of primary testicular lymphoma with spread to the inguinal lymph node was considered.