Department of Urology, Mercy University Hospital, Cork, Ireland
Department of Histopathology, Cork University Hospital, Cork, Ireland.
BMJ Case Rep. 2021 Dec 31;14(12):e247381. doi: 10.1136/bcr-2021-247381.
A 72-year-old man was referred to our urology outpatient department with a left hemi-scrotal swelling increasing in size over a matter of weeks, initially suspicious for a left hydrocoele. Initial investigation with ultrasound (US) identified a heterogenous enlargement of the left testis and epididymis with a soft tissue mass extending through the inguinal canal. Subsequent CT detected this soft tissue mass to extend along the left gonadal vein to the level of the left renal vein. A biopsy of the retroperitoneal mass confirmed a diagnosis of diffuse large B-cell lymphoma. Immunohistochemical staining further categorised this lymphoma as double expressor but not double hit.Through multidisciplinary team involvement the patient was treated with combination steroids and chemotherapy. Given the scrotal involvement this was considered a sanctuary site for chemotherapy therefore the patient also received radiotherapy to the scrotum. He recovered well following his treatment. This case highlights how early specialist referral can identify rare variants of disease. Essential preoperative imaging with US prior to treating a presumed hydrocoele prevented inappropriate surgical excision. A multidisciplinary team approach improved the patient's outcome and is hoped to have improved his chances of recurrence-free survival.
一位 72 岁男性因左侧阴囊肿胀逐渐增大数周，最初怀疑为左侧阴囊积水，被转至我们泌尿科门诊。初步超声（US）检查发现左侧睾丸和附睾不均匀增大，伴有软组织肿块通过腹股沟管延伸。随后的 CT 检测到该软组织肿块沿着左侧精索静脉延伸至左肾静脉水平。腹膜后肿块的活检证实诊断为弥漫性大 B 细胞淋巴瘤。免疫组化染色进一步将该淋巴瘤归类为双表达但非双打击。通过多学科团队的参与，患者接受了类固醇和化疗的联合治疗。鉴于阴囊受累，这被认为是化疗的避难所部位，因此患者还接受了阴囊放疗。他在治疗后恢复良好。这个病例强调了早期专科转诊可以识别出罕见的疾病变异。在治疗疑似阴囊积水之前，进行 US 等基本术前影像学检查可避免不当的手术切除。多学科团队的方法改善了患者的预后，并有望提高其无复发生存率。
