A 64-year-old male was admitted to Department of Urology, Jichi Medical School Hospital, because of asymptomatic swelling of the right testis. He underwent orchiectomy on March 2, 1984. Histological examination of the removed tumor disclosed non-Hodgkin's lymphoma (NHL), diffuse, medium sized cell type (Lymphoma Study Group). He moved to our department for further evaluation.
Physical examination revealed bilateral inguinal lymphadenopathy. Histological examination of the lymphnode obtained by biopsy disclosed no involvement of NHL. The level of serum lactate dehydrogenase (LDH) was initially high, but its level was normalized following orchiectomy. Examination by chest X-ray, lymphangiography, abdominal ultrasonography performed before orchiectomy were normal. Examination of films of Gallium-67 scan, computed tomography, bone scan, liver-spleen scan, and barium study of the upper gastro-intestinal tract which were performed after orchiectomy revealed no abnormalities. Histology of bone marrow obtained by trephine biopsy was normal. Therefore, this case was considered to have clinical stage IE lymphoma.
In April, para-aortic lymphnode swelling was detected by ultrasonography, and LDH level elevated again. The patient was irradiated to para-aortic and pelvic fields in a total dose of 30.4 Gy. Thereafter, chemotherapy was initiated with cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP). He remained in complete remission for 12 months.
In the literature, the prognosis of patients with testicular NHL has been poor. In most of the patients, lymphoma was initially localized to the testis, but generalized dissemination of the disease developed within a short time. Therefore, besides orchiectomy and radiation therapy, systemic chemotherapy appeared to play a role in the treatment of the most patients with testicular NHL.
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