testicular lymphoma
Introduction
Introduction to testicular lymphoma Testicular lymphoma is rare, accounting for about 5% of testicular tumors. DoLL et al. summarized 7743 testicular tumors, including 360 cases of malignant lymphoma originating in the testis, accounting for 4.6%. This disease is the most common in the age group over 60 years old. Testicular tumor. basic knowledge The proportion of illness: 0.001% Susceptible people: good for people over 60 years old Mode of infection: non-infectious complication:
Cause
Causes of testicular lymphoma
(1) Causes of the disease
Some patients have a history of testicular trauma, orchitis or spermatic filariasis, and testicular insufficiency is extremely rare. However, the exact cause of the disease is still unclear.
(two) pathogenesis
The size of testicular lymphoma varies greatly, often involving the epididymis and spermatic cord and seminal vesicle, but the sheath and scrotal skin are rarely involved. Testicular lymphoma has different structures. Most of the reported cases have medium to high grade, diffuse large cell lymphoma. It is the most common type. Inexperienced pathologists can easily diagnose primary testicular lymphoma as seminoma. If the patient is elderly, it should be considered whether it is lymphoma. The extent of the disease is the most important factor in diagnosis. Lymph node metastasis (grade 2), especially large lymphadenopathy, often has a poor prognosis. Other diagnostic factors include the size of the primary tumor (greater than 9 cm), the presence of systemic syndrome, and age greater than 65 years.
Gross specimen: gross specimen of testicular tumor, the tumor mainly invades the testicular body, usually covered by intact testicular sheath, the seminal vesicle and epididymis are generally invaded, the specimens are generally observed, the tumor structure is evenly arranged, the testicles are diffusely invaded, often knotted The knot can be multiple or single, often accompanied by hemorrhage and necrosis, usually gray, light yellow, light red and brown.
Seen under the microscope: testicular lymphoma, almost all non-Hodgkin's lymphoma, Hodgkin's lymphoma is extremely rare, except for the histological structure of individual patients is nodular lymphoma, all testicular lymphoma is diffuse, However, because the early years of the case did not use a uniform classification criteria, the terms used were not the same, most of the classification was reticulocyte sarcoma, followed by lymphocytic lymphoma, and most of the clinical reports were later classified by Rappaport. In a group of 170 patients classified by this method, diffuse histiocytotype accounted for 76%; poorly differentiated lymphocyte type accounted for 14%; diffuse mixed cell type accounted for 3%; other types accounted for 7%, and Rappaport classification was diffuse A histiocytic lymphoma is actually a group of immunologically and morphologically complex diseases. Basically, this subtype is classified as a poor prognosis of lymphoma. Paladugu et al. reported 20 cases of diffuse histiocytic lymphoma. Tumors, 19 of which were large non-cracked cell types, had a poor prognosis and were not sensitive to chemotherapy compared with large lymphoblastic lymphoma, using an international work programme classification, 3 series of 69 testes In the case of pill lymphoma, 47 cases were moderately malignant, 21 cases were highly malignant, and only 1 case was low malignant.
Prevention
Testicular lymphoma prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Testicular lymphoma complications Complication
1. Merging the central nervous system
The lesions were mainly meninges, epidural space and brain parenchyma. Turner et al reported 30 cases of testicular lymphoma, 9 cases of central nervous system invasion, 5 cases of meninges, 2 cases of epidural, 1 case of brain parenchyma and 1 In the epidural space, the meninges were invaded, Read reported 51 cases of testicular lymphoma, 9 cases of central nervous system invasion, related to histological subtypes, lymphocytes and diffuse undifferentiated most common, diffuse tissue Cell type and diffusely differentiated lymphoma are second.
2. The chances of combining lung infiltration are also common.
Sussman et al reported 37 patients, 9 had lung invasion, Read reported 51 cases of testicular lymphoma, and 8 cases of lung invasion, and the autopsy results reported by different authors, the incidence of lung invasion was as high as 50% to 86%.
Symptom
Testicular lymphoma symptoms common symptoms weight loss nodule anorexia
Most patients show that the testicles are painless, swollen, falling, and lasting for several weeks to several months. Occasionally, for a few years, a small number of patients have pain, the testis is hard, the surface is smooth or nodules, and the late stage can be accompanied. There are systemic symptoms such as anemia, weight loss, anorexia, fever, skin, damage to the Wechsler ring and surrounding tissues.
In addition to the above-mentioned sites, multi-organized dissemination often occurs in the terminal stage of the disease, including lymph nodes, bone marrow, spleen, skin, central nervous system and lungs, and lymphocytic leukemia.
Examine
Testicular lymphoma examination
Histopathological examination confirmed lymphoma.
Complete blood count, bone marrow, liver and kidney function and serum biochemical examination, due to the greater chance of meningeal invasion, lumbar puncture hydrocephalus cytology is also necessary, abdominal CT and lymphangiography is necessary for clear staging, such as doubt Liver invasion, percutaneous liver puncture and laparoscopic liver biopsy should be performed.
Diagnosis
Diagnosis and differentiation of testicular lymphoma
diagnosis
Testicular lymphoma is mainly dependent on the acquisition of primary tumor histological specimens. In addition, attention should be paid to regional lymph nodes and distal metastases including the Waldeyer lymphatic, lung, bone, pleura, skin and central nervous system, retroperitoneal cavity and thoracic CT. Scanning is helpful for the diagnosis and staging of the disease. Because the bone marrow and central nervous system are invaded, cytology of bone marrow and cerebrospinal fluid should be performed. The diagnosis of testicular lymphoma depends on pathology. After pathological classification, the medical history is detailed, and there are B symptoms, such as fever, night sweats or weight loss. When examining the body, you should pay attention to whether there is a lump in the contralateral testis, and whether the lymph nodes above and below the diaphragm are affected. Invasion, liver, spleen is swollen, pay special attention to the Vickers ring and surrounding tissues and skin are invaded.
Differential diagnosis
Testicular lymphoma is often misdiagnosed as seminoma, sometimes misdiagnosed as embryonal cancer, misdiagnosis rate can be as high as 30% to 35%, due to different treatment methods, the correct distinction between testicular germ cell tumor and lymphoma is particularly important.
Gowing believes that testicular malignant lymphoma usually has the following characteristics, which helps to distinguish from seminoma:
1 cells are small and have low cytoplasm and high nuclear/mass ratio;
2 The content of glycogen in the cytoplasm is small (the content of glycogen in the cytoplasm of spermatogonoma is very high);
3 diffuse tubule invasion, residual tubules can be seen, even if buried deeply in the tumor, residual tubules can still be seen;
4 reticular fiber dyeing, it can be seen that the small tube is surrounded by the woven layer, showing a unique shape;
5 characteristic violation of the vein wall;
6 no intra-testicular dissemination around the testicles;
7 lack of interstitial granuloma reaction;
8 mainly occurs in the elderly.
Embryonic carcinoma has epithelial-like characteristics, usually forming granulation, nipple or tubule structure, and in some patients serum alpha-fetoprotein (FP) and/or chorionic gonadotropin (hCG) levels are elevated, therefore, these markers are measured Helps to differentiate the diagnosis.
In addition, it needs to be differentiated from granulomatous orchitis, pseudolymphoma, plasmacytoma and rhabdomyosarcoma.
