Zuo YZ, Liang Z, Pan BJ, Yan WG, Zhou ZE. Primary testicular diffuse large B-cell lymphoma with gonadal vein tumor thrombus: A case report and review of the literature. World J Clin Oncol 2025; 16(11): 111527 [DOI: 10.5306/wjco.v16.i11.111527]
Corresponding Author of This Article
Wei-Gang Yan, Professor, Department of Urology, Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100005, China. yanweigang@pumch.cn
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 24, 2025 (publication date) through Nov 21, 2025
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Journal Information of This Article
Publication Name
World Journal of Clinical Oncology
ISSN
2218-4333
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Zuo YZ, Liang Z, Pan BJ, Yan WG, Zhou ZE. Primary testicular diffuse large B-cell lymphoma with gonadal vein tumor thrombus: A case report and review of the literature. World J Clin Oncol 2025; 16(11): 111527 [DOI: 10.5306/wjco.v16.i11.111527]
Yu-Zhi Zuo, Zhen Liang, Bo-Ju Pan, Wei-Gang Yan, Zhi-En Zhou, Department of Urology, Peking Union Medical College, Beijing 100005, China
Co-first authors: Yu-Zhi Zuo and Zhen Liang.
Co-corresponding authors: Wei-Gang Yan and Zhi-En Zhou.
Author contributions: Zuo YZ and Liang Z contributed equally to this work as co–first authors. Zuo YZ took primary responsibility for study conception and design, performed comprehensive collection of clinical data, drafted the initial manuscript, conducted literature review, integrated the case findings into the scientific context, and contributed to the preparation of figures and tables; Liang Z assisted in study design, managed the acquisition and organization of clinical and laboratory data, performed statistical and descriptive analyses, participated in drafting substantial sections of the manuscript, and provided critical revisions to improve clarity and scientific rigor. Yan WG and Zhou ZE contributed equally to this work as co–corresponding authors. Yan WG provided overall supervision of the project, guided the clinical interpretation of the case, critically revised the manuscript for intellectual content, coordinated communication among the research team, and ensured methodological accuracy; Zhou ZE was responsible for methodological guidance.
Informed consent statement: Written informed consent was obtained from the patient for publication of anonymized clinical data and images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Gang Yan, Professor, Department of Urology, Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100005, China. yanweigang@pumch.cn
Received: July 3, 2025 Revised: August 2, 2025 Accepted: October 10, 2025 Published online: November 24, 2025 Processing time: 142 Days and 18.1 Hours
Abstract
BACKGROUND
Primary testicular lymphoma (PTL) is a rare, aggressive malignancy, representing a small fraction of testicular tumors and non-Hodgkin lymphomas, yet it is the most common testicular malignancy in older men. Diffuse large B-cell lymphoma (DLBCL), which is typically the aggressive subtype, dominates PTL and shows diffuse B-cell infiltration. Venous tumor thrombus, uncommon in lymphomas, is uniquely reported in this case of testicular DLBCL with gonadal vein involvement.
CASE SUMMARY
A 62-year-old man presented with a two-month history of painless left testicular swelling and stiffness. Diagnostic imaging [ultrasonography, computed tomography (CT), and 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG-PET/CT)] revealed bilateral testicular masses and a gonadal vein tumor thrombus (SUVmax 16.5). Left orchiectomy confirmed DLBCL with CD20, Bcl-2, and MUM1 positivity (Ki-67: approximately 80%). The disease was staged as Ann Arbor stage IVA (International Prognostic Index score 3, high-intermediate risk). The patient received Rituximab, Polatuzumab Vedotin, Cyclophosphamide, Epirubicin, and Prednisolone chemotherapy, completing the first cycle with good tolerability. No adverse events were reported, and follow-up is ongoing to assess long-term outcomes. This case highlights the diagnostic utility of 18F-FDG-PET/CT and the importance of multidisciplinary management in rare PTL presentations with tumor thrombus.
CONCLUSION
This case demonstrates the diagnostic complexities of PTL with gonadal vein tumor thrombus, underscoring the importance of considering lymphoma in elderly patients with testicular masses and venous involvement. A multi-disciplinary team including urologists, hematologists, and radiation oncologists is needed to ensure appropriate therapy.
Core Tip: This is the first reported case of primary testicular diffuse large B-cell lymphoma presenting with a gonadal vein tumor thrombus, a manifestation previously unrecognized in this malignancy. The case underscores the pivotal role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in detecting rare vascular involvement and guiding staging. It also highlights the importance of a multidisciplinary approach in managing advanced-stage primary testicular lymphoma, which remains a rare but aggressive disease with distinct diagnostic and therapeutic challenges.
