BILATERAL SYNCHRONOUS PRIMARY TESTICULAR LYMPHOMA IN THE ELDERLY

INTRODUCTION

Primary testicular lymphoma (PTL) typically occurs in individuals over 60 years of age. It represents
1-9% of testicular tumors and 1-2% of all non-Hodgkin lymphomas. The common histotype of PTL
is diffuse large B-cell lymphoma. Synchronous testicular involvement occurs in 3% of PTL cases.

CLINICAL CASE

A 67-year-old patient presents with fever, nausea, and pain in the buttocks. He has a history of
smoking and cocaine use for 10 years. Leukocytosis with neutrophilia and LDH: 679 U/L. PCR for
SARS-CoV-2 is positive. Hard and painful nodules are palpated in both testicles, confirmed by
ultrasound. Tumor markers are negative. CT scan: post-procedure. Drainage of gluteal and perineal
abscess is performed due to Fournier's gangrene. Blood cultures and abscess secretion reveal
methicillin-resistant Staphylococcus aureus sensitive to vancomycin. Bilateral orchiopexy is
performed through inguinal access with intraoperative biopsy, which reports morphological
findings consistent with a lymphoproliferative process. Immunohistochemical analysis indicates
peripheral B-cell non-Hodgkin lymphoma, mature subtype, and diffuse large cell lymphoma of the
testicle according to the WHO classification. The patient is referred to an extrahospital
Oncohematology service for further chemotherapy treatment.

CONCLUSIONS

PTL is a rare tumor, and bilateral involvement is extremely rare. It carries a poor prognosis with a
tendency for systemic spread. Diagnosis is often delayed due to confusion with chronic orchitis.
The treatment of choice is orchiectomy, with or without radiotherapy, and chemotherapy.
However, due to its low frequency, there is no standardized treatment protocol for PTL.