Novella G, Porcaro A B, Righetti R, Cavalleri S, Beltrami P, Ficarra V, Brunelli M, Martignoni G, Malossini G, Tallarigo C
Department of Urology, University of Verona, Italy.
Urol Int. 2001;67(1):97-9. doi: 10.1159/000050957.
To report an extremely rare clinical pathological observation of a case of primary lymphoma of the epididymis, without testicular or systemic involvement, and to update the relevant literature.
A 25-year-old white male patient complaining of right scrotal pain was referred to our department. Clinical examination detected a hard painful mass at the right epididymal head. Epididymitis was diagnosed and conservative therapy with antibiotics and anti-inflammatory drugs was given. After 2 months of therapy the patient was admitted to our department because a tumor was suspected. Tumor markers were normal. Right scrotal exploration was performed through a standard inguinal incision. The epididymal head was completely replaced by a hard white mass. Fresh frozen sections indicated a malignant tumor. Right radical orchiectomy was performed.
High-grade primary epididymal non-Hodgkin's lymphoma with diffuse large cells (group G according to the Working Formulation) was diagnosed. Clinical pathological staging detected stage IE (extranodal) primary epididymal lymphoma. The patient was referred to the Hematologic Unit for combined chemotherapy, according to the VACOP-B protocol. After an 18-month follow-up the patient is well and disease free.
When an epididymal mass does not benefit from medical treatment, scrotal exploration and fresh frozen sections of the lesion should be done. The possible bilateral involvement by primary epididymal lymphoma has to be kept in mind. Radical orchiectomy is the treatment of choice for primary lymphoma of the epididymis. Adjuvant chemotherapy is indicated in high-grade malignant lymphoma. Prognostic parameters of the disease may be the grade of malignancy and the size of the tumor.
报告1例极为罕见的附睾原发性淋巴瘤临床病理观察结果，该病例无睾丸及全身受累情况，并对相关文献进行更新。
一名25岁白人男性患者因右侧阴囊疼痛转诊至我科。临床检查发现右侧附睾头部有一坚硬压痛性肿块。诊断为附睾炎，给予抗生素及抗炎药物进行保守治疗。治疗2个月后，因怀疑肿瘤，患者入住我科。肿瘤标志物正常。通过标准腹股沟切口对右侧阴囊进行探查。附睾头部完全被一坚硬白色肿块取代。新鲜冰冻切片显示为恶性肿瘤。遂行右侧根治性睾丸切除术。
诊断为高级别原发性附睾非霍奇金淋巴瘤，伴有弥漫大细胞（根据工作分类法为G组）。临床病理分期为IE期（结外）原发性附睾淋巴瘤。根据VACOP - B方案，患者被转诊至血液科进行联合化疗。经过18个月的随访，患者情况良好，无疾病复发。
当附睾肿块经药物治疗无效时，应进行阴囊探查及病变的新鲜冰冻切片检查。必须牢记原发性附睾淋巴瘤可能存在双侧受累情况。根治性睾丸切除术是附睾原发性淋巴瘤的首选治疗方法。高级别恶性淋巴瘤需进行辅助化疗。该疾病的预后参数可能为恶性程度及肿瘤大小。
