McDermott M B, O'Briain D S, Shiels O M, Daly P A
Department of Histopathology, St. James's Hospital, Dublin, Ireland.
Cancer. 1995 Apr 15;75(8):2174-9. doi: 10.1002/1097-0142(19950415)75:8<2174::aid-cncr2820750823>3.0.co;2-s.
Malignant lymphoma of the testis involves the adjacent epididymis in approximately 60% of cases, but isolated epididymal lymphoma is rare.
The file of a 34-year-old man was reviewed, and the biopsy material was studied by conventional morphology, immunohistochemistry, and polymerase chain reaction.
The patient presented with painless bilateral epididymal enlargement. Sequential bilateral epididymal biopsies revealed follicular lymphoproliferation with minimal involvement of one testis. Immunoglobulin M antibodies to the Coxsackie B4 virus were increased, and the lesions were interpreted as an atypical reactive process. Chemotherapy was not pursued. Four years after presentation, there was no evidence of local disease, but a 3-cm lesion involving the skin of the forehead developed. An excision biopsy revealed a large cell follicular lymphoma with features resembling the epididymal lesion. Analysis by polymerase chain reaction revealed a t(14-18) translocation in skin and epididymal lesions confirming that the epididymal lesions were also lymphomatous. Staging revealed no other site of disease. To date, the patient, who was treated with methotrexate chemotherapy, remains well 28 months after treatment.
Most lymphomas of the testis and epididymis occur in older men, have an intermediate or high grade, diffuse histology, disseminate early, and follow an aggressive clinical course. In contrast, this case is similar to the occasional reports of pseudolymphoma and follicular lymphoma that occur in younger men, are confined largely to the testis and epididymis, and have a good prognosis.
睾丸恶性淋巴瘤约60%的病例累及相邻附睾，但孤立性附睾淋巴瘤罕见。
回顾一名34岁男性的病历，并通过传统形态学、免疫组织化学和聚合酶链反应对活检材料进行研究。
该患者表现为双侧附睾无痛性肿大。双侧附睾连续活检显示滤泡性淋巴细胞增殖，一侧睾丸仅有轻微受累。柯萨奇B4病毒免疫球蛋白M抗体升高，病变被解释为非典型反应性过程。未进行化疗。就诊4年后，无局部疾病证据，但前额皮肤出现一个3厘米的病变。切除活检显示为大细胞滤泡性淋巴瘤，其特征与附睾病变相似。聚合酶链反应分析显示皮肤和附睾病变存在t(14;18)易位，证实附睾病变也是淋巴瘤性的。分期检查未发现其他疾病部位。迄今为止，接受甲氨蝶呤化疗的该患者在治疗后28个月情况良好。
大多数睾丸和附睾淋巴瘤发生于老年男性，组织学类型为中或高级别、弥漫性，早期播散，临床病程侵袭性强。相比之下，该病例类似于偶尔报道的发生于年轻男性的假性淋巴瘤和滤泡性淋巴瘤，主要局限于睾丸和附睾，预后良好。
