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Khan M, Rajarubendra N, Azer S, Skene A, Harrison SJ, Campbell B, Lawrentschuk N. Plasmacytoma of the testis in a patient with relapsed and refractory multiple myeloma: Case report and review of the literature. Urol Ann 2015; 7:530-3. [PMID: 26692682 PMCID: PMC4660713 DOI: 10.4103/0974-7796.164844] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Testicular plasmacytoma, whether occurring as a primary lesion or as a reflection of underlying multiple myeloma (MM), is a rare disease. We report the case of a 38-year-old male with multiply relapsed MM, who was found to have a testicular plasmacytoma. He presented with a gradually enlarging scrotal mass. Following orchidectomy, pathologic examination of the specimen demonstrated a plasmacytoma. In the context of active MM, the specimen was also sent for cytogenetic analysis but this was unhelpful in guiding a chemotherapy regime, which still continues at time of reporting. Although a rare lesion, there remains no definitive treatment protocol for the management of testicular plasmacytoma representing an extramedullary manifestation of MM.
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Affiliation(s)
- Munad Khan
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | | | - Sarah Azer
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Alison Skene
- Department of Pathology, Austin Hospital, Melbourne, Australia
| | - Simon J Harrison
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia ; Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia
| | - Belinda Campbell
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia ; Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia ; Olivia Newton-John Cancer Research Department, Austin Hospital, Melbourne, Australia ; Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
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Filho MG. Primary testicular plasmocytoma: A five year follow-up. Urol Ann 2013; 5:39-41. [PMID: 23662009 PMCID: PMC3643322 DOI: 10.4103/0974-7796.106965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 07/19/2011] [Indexed: 11/29/2022] Open
Abstract
The testicular plasmocytoma represents only 5% of the non-germinative cell testicular tumors, and accounts for only 2% of all plasma cell neoplasms. Approximately, 50 cases of testicular plasmocytoma have been reported in medical literature; however, only 9 of these are isolated tumors without previous history or progression to multiple myeloma. A 47-year-old patient, presenting progressive and painless growth of the right testicle in the last four years, underwent surgical treatment in another hospital two years ago, to correct a hydrocele in the same testicle with no improvement at all. Sonography showed a tumor with the following measurements for the right testicle: 84 × 59 × 80 mm. The tumor marker values were all normal. An abdominal computed tomography found no evidence of retroperitoneal lymph nodes invasion. The patient underwent a right radical orchiectomy. Pathologic analysis revealed a malignant neoplasia described as a plasmocytoma (solitary myeloma) that produces immunoglobulin's kappa light chain. After five years of follow-up, there were no signs of metastasis or local recurrence in the exams. Case report and review of literature have been presented here.
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Affiliation(s)
- Milton Ghirelli Filho
- Grajaú Hospital Urological Clinic, Grajaú Hospital, Rua Francisco Otávio Pacca, 180, Grajaú, São Paulo, SP, Brazil
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Primary plasmacytoma of the testis with no evidence of multiple myeloma: a new case report and literature review. AFRICAN JOURNAL OF UROLOGY 2010. [DOI: 10.1007/s12301-010-0019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Li D, Xie P, Mi C. Primary testicular diffuse large B-cell lymphoma shows an activated B-cell-like phenotype. Pathol Res Pract 2010; 206:611-5. [PMID: 20627604 DOI: 10.1016/j.prp.2010.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 02/23/2010] [Accepted: 04/02/2010] [Indexed: 11/29/2022]
Abstract
The most common type of primary testicular lymphoma is diffuse large B-cell type, which has a poor prognosis relative to other extra-nodal diffuse large B-cell lymphomas (DLBCL). These constitute a heterogeneous group of lymphomas with germinal center B-cell-like and activated B-cell-like subtypes. Such a distinction theoretically utilizes the immunohistochemical expression of CD10, Bcl-6, and MUM1. The purpose of this study was that we could stratify primary testicular lymphoma of diffuse large B-cell type according to this scheme, and further elucidate the reason why primary testicular diffuse large B-cell lymphoma possesses a poor clinical outcome. Seventeen Chinese patients with primary testicular DLBCL were examined by means of a 3-antibody panel (CD10, Bcl-6, MUM1). Among these 17 cases, 16 were assigned to the activated B-cell-like subtypes. One case was classified as germinal center B-cell-like type. Twelve of these 17 cases expressed high proliferative activity (>or=40% Ki-67 labeling). The majority of primary testicular DLBCLs have activated B-cell-like subtype characteristics and high proliferative activity. These features might be a significant factor; moreover, they are associated with poor prognosis.
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Affiliation(s)
- Dan Li
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Yuzhong Dist., Chongqing, China.
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Loong F, Chan ACL, Ho BCS, Chau YP, Lee HY, Cheuk W, Yuen WK, Ng WS, Cheung HL, Chan JKC. Diffuse large B-cell lymphoma associated with chronic inflammation as an incidental finding and new clinical scenarios. Mod Pathol 2010; 23:493-501. [PMID: 20062008 DOI: 10.1038/modpathol.2009.168] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Diffuse large B-cell lymphoma that develops in the setting of long-standing chronic inflammation is typically associated with Epstein-Barr virus, and usually presents as tumor mass involving body cavities, as in pyothorax-associated lymphoma. It is listed as a distinct entity in the latest World Health Organization lymphoma classification. We report four cases that were incidentally discovered on histologic examination, one each in a splenic false cyst, a long-standing hydrocele, an atrial myxoma, and metallic-implant wear debris. Microscopic foci of atypical (neoplastic) large lymphoid cells were found within the contents of the cysts or curettage material, or within the stroma of the atrial myxoma. Despite the diverse clinical scenarios, all cases showed a homogeneous phenotype: positivity for B-lineage markers (CD20+, CD79a+, PAX5+), non-germinal center immunophenotype (CD10-, BCL6-/+, MUM-1+), and positivity for Epstein-Barr virus with type III latency (LMP1+, EBNA2+). The last feature supports the hypothesis that the lymphoma has arisen in a setting of 'local immunodeficiency' as a result of long-standing chronic inflammation in an enclosed space, a characteristic pathogenetic mechanism of diffuse large B-cell lymphoma associated with chronic inflammation. These cases therefore expand the spectrum of this entity to include new clinical scenarios for the development of this lymphoma type.
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Affiliation(s)
- Florence Loong
- Department of Pathology, Queen Mary Hospital, Hong Kong, China.
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Hassen-Troudi F, Mege-Lechevallier F, Colombel M, Scoazec JY. [Testicular localisation of a plasmocytoma]. Ann Pathol 2009; 29:32-5. [PMID: 19233092 DOI: 10.1016/j.annpat.2008.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2008] [Indexed: 10/21/2022]
Abstract
Testicular plasmocytomas are rare neoplasias that may occur as isolated tumors or in concomitance with a multiple myeloma. We report the case of a 47-year-old man with previous history of multiple myeloma. He presented with persistant fever and right testicular mass which was confirmed by scrotal sonography examination. A right orchiectomy was performed. The histological examination showed a plasmocytoma and immunohistochemical stains revealed monoclonal light chain lambda in tumor cells.
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Affiliation(s)
- Fayrouz Hassen-Troudi
- Service d'anatomie et cytologie pathologiques, hôpital Edouard-Herriot, 69437 Lyon cedex 03, France
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Al-Abbadi MA, Hattab EM, Tarawneh M, Orazi A, Ulbright TM. Primary testicular and paratesticular lymphoma: a retrospective clinicopathologic study of 34 cases with emphasis on differential diagnosis. Arch Pathol Lab Med 2007; 131:1040-6. [PMID: 17616989 DOI: 10.5858/2007-131-1040-ptapla] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2006] [Indexed: 11/06/2022]
Abstract
CONTEXT Recent reports indicate the rate of primary testicular lymphomas is on the rise and misdiagnosis can still occur. OBJECTIVE To review and investigate the clinicopathologic features of primary testicular lymphoma with emphasis on the differential diagnosis. Discussion about the issue of misdiagnosis is also presented. DESIGN Retrospective review of pathology archives in 3 medical centers for cases fulfilling criteria of primary testicular lymphoma or paratesticular lymphoma was carried out. Clinicopathologic and immunohistochemical features were studied and analyzed. RESULTS The search identified 34 cases. Patients ranged from 4 to 87 years of age (mean, 55 years). All presented with a testicular/paratesticular mass and were stage I. The masses ranged from 2.5 to 13 cm (mean, 5.6 cm). Microscopically, the tumors often had an intertubular growth pattern or diffuse arrangement of predominantly large cells with pleomorphic, twisted nuclei and small nucleoli. Mitotic activity was brisk and apoptotic bodies were abundant. Thirty-two tumors were classified as diffuse large cell lymphomas; immunophenotype was determined in 21 of these and all were of B-cell type. The median survival was 96 months. The rate of initial misdiagnosis was unexpectedly high (5 cases, 15%). CONCLUSIONS Most cases of primary testicular lymphoma fall into the broad category of diffuse large cell lymphoma and the majority are B-cell type with particularly high proliferative activity when characterized by appropriate immunophenotyping. Misdiagnosis can occur, especially in those cases in which presentation occurs at an age similar to that for germ cell tumors, showing the need for caution and appropriate immunostaining when a testicular neoplasm has an atypical appearance for a germ cell tumor.
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Affiliation(s)
- Mousa A Al-Abbadi
- Department of Pathology, Wayne State University/Detroit Medical Center, Detroit, Mich, USA
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Al-Abbadi MA, Hattab EM, Tarawneh MS, Amr SS, Orazi A, Ulbright TM. Primary testicular diffuse large B-cell lymphoma belongs to the nongerminal center B-cell-like subgroup: A study of 18 cases. Mod Pathol 2006; 19:1521-7. [PMID: 16998463 DOI: 10.1038/modpathol.3800691] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The most common type of primary testicular lymphoma is diffuse large B-cell type, which has the potential for aggressive clinical behavior. Diffuse large B-cell lymphoma can be further subclassified into two major prognostic categories: germinal center B-cell-like and nongerminal center B-cell-like. Such distinction is made possible using the immunohistochemical expression of CD10, Bcl-6 and MUM1. The aim of this study was to stratify primary testicular lymphoma of the diffuse large B-cell type according to this scheme. Immunohistochemical stains for CD10, Bcl-6 and MUM1 were performed on 18 cases of primary testicular lymphoma of diffuse large B-cell type. Subclassification was carried out as previously described where CD10 and/or Bcl-6 positivity and negativity for MUM1 were considered indicative of germinal center B-cell-like type and the opposite expression as nongerminal center B-cell-like type. The proliferative activity was determined using immunostaining with the Ki-67 antibody. Of 18 cases, 16 (89%) were found to belong to the nongerminal center B-cell-like type. Two cases (11%) were classified as germinal center B-cell-like type; one had a CD10-positive, Bcl-6-positive and MUM1-negative profile, and the other was CD10 negative, Bcl-6 positive and MUM1 negative. The former occurred in a 38-year-old patient who was human immunodeficiency virus positive. All the cases expressed high proliferative activity (> or =50% Ki-67 labeling). We conclude that most (89%) primary testicular lymphomas of the diffuse large B-cell type belong to the nongerminal center B-cell-like subgroup and have high proliferative activity.
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Lee JS, Choi YD, Choi C. Primary testicular osteosarcoma with hydrocele. Virchows Arch 2004; 445:210-3. [PMID: 15232746 DOI: 10.1007/s00428-004-1073-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 06/07/2004] [Indexed: 10/26/2022]
Abstract
Primary testicular osteosarcoma is an extremely rare malignancy. To date, only two cases have been reported. Here, we report a third case of primary testicular osteosarcoma complicated with hydrocele. A 78-year-old man presented with right scrotal swelling. Ultrasonography revealed hydrocele and a testicular heterogeneous solid mass with focal calcification in the right testis. Right inguinal orchiectomy revealed a pure intratesticular osteosarcoma. Retroperitoneal lymph-node dissection revealed no metastasis. Thorough sampling of the tumor failed to show any additional histological components. It is unlikely that our case arose from teratoma or mixed sex-cord/stromal tumor, because no other neoplastic elements were identified in whole sampling of the tumor. He remained well without evidence of disease 44 months after operation. This case illustrates that primary pure testicular osteosarcoma may be associated with a favorable prognosis.
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Affiliation(s)
- Ji Shin Lee
- Department of Pathology, Chonnam National University Medical School and Hospital, 5 Hakdong, Dongku, 501-746 Gwangju, Korea.
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Hou TY, Dai MS, Kao WY. Testicular plasmacytoma with bone dissemination without medullary plasmacytosis. Ann Hematol 2003; 82:518-520. [PMID: 12838369 DOI: 10.1007/s00277-003-0672-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2003] [Accepted: 04/13/2003] [Indexed: 10/26/2022]
Abstract
A 34-year-old man was diagnosed as having solitary testicular plasmacytoma. He had received palliative radiotherapy, several combined chemotherapies including CHOP chemotherapy (vincristine, cyclophosphamide, Adriamycin, and prednisone), MP (melphalan and prednisone) and M-2 protocol (melphalan, prednisone, vincristine, carmustine, and cyclophosphamide), and interferon therapy as 3 million units subcutaneous injection three times a week for 1 year. Extensive bone plasmacytoma developed 7 years later without bone marrow involvement. We suggest that early use of combined chemoradiotherapy and high-dose chemotherapy with autologous stem cell support should be investigated in patients with testicular plasmacytoma with dissemination.
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Affiliation(s)
- T Y Hou
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
| | - M S Dai
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan.
| | - W Y Kao
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan
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