Primary testicular diffuse large B-cell lymphoma with gonadal vein tumor thrombus: A case report and review of the literature

Table 1 Timeline of case report: Primary testicular diffuse large B-cell lymphoma with gonadal vein tumor thrombus

Time point	Event	Details
Month 0	Onset of symptoms	A 62-year-old man noticed painless swelling and stiffness in the left testis, lasting for two months. No associated systemic symptoms (e.g., fever, night sweats, weight loss). ECOG performance status: 0
Month 2	Initial clinical evaluation	Physical examination: Left testis enlarged (7 cm × 5 cm), non-tender, with a solid mass on transillumination. Right testis normal. No peripheral lymphadenopathy. Laboratory tests: Complete blood count, liver/renal function, and coagulation parameters normal. Tumor markers: LDH 181 U/L (normal: 0-250 U/L), AFP 2.1 ng/mL (normal: ≤ 20 ng/mL), β-HCG < 0.6 IU/L (normal: < 5 IU/L). HIV antibodies negative
Month 2 (cont.)	Diagnostic imaging	Ultrasonography: Left testis enlarged (5.4 cm × 5.1 cm × 4.0 cm) with heterogeneous echogenicity, spermatic cord involvement, and hydrocele (fluid depth approximately 2 cm). Right testis showed smaller heterogeneous low-echo areas (4.8 cm × 3.2 cm × 2.1 cm). Contrast-enhanced CT (abdomen/pelvis): Irregularly enhancing bilateral testicular masses (left: 5.6 cm × 3.9 cm), thickened left gonadal vein and spermatic cord. 18F-FDG-PET/CT: Increased FDG uptake in left testis (SUVmax 14.1), right testis (SUVmax 5.0), and linear uptake along left gonadal vein (SUVmax 16.5, suggestive of tumor thrombus). Metabolically active lymph nodes in right clavicular region, mediastinum, paravertebral area, bilateral crura, and retroperitoneum, indicating possible metastases
Month 2-3	Surgical intervention	Left inguinal orchiectomy: Performed for diagnosis. Pathological findings: Diffuse tumor cell infiltration in testicular tissue, extending to spermatic cord margin. Immunohistochemistry confirmed DLBCL (positive for CD20, Bcl-2, MUM1; 50% Bcl-6 positivity; Ki-67 approximately 80%)
Month 3	Staging and additional tests	Bone marrow biopsy and cerebrospinal fluid analysis: Normal, no malignant cells detected. Staging: Ann Arbor stage IVA, International Prognostic Index score 3 (high-intermediate risk, based on age > 60, stage IV, extranodal disease)
Month 3 (cont.)	Treatment initiation	Chemotherapy: Patient received first cycle of rituximab, polatuzumab vedotin, cyclophosphamide, epirubicin, and prednisolone. Outcome: Good tolerability to the first cycle, with ongoing follow-up to assess long-term outcomes

ECOG: Eastern Cooperative Oncology Group; LDH: Lactate dehydrogenase; AFP: Alpha-fetoprotein; β-HCG: Beta-human chorionic gonadotropin; HIV: Human immunodeficiency virus; CT: Computed Tomography; 18F-FDG-PET/CT: Fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography; FDG: Fluorodeoxyglucose; SUVmax: Maximum standardized uptake value; DLBCL: Diffuse large B-cell lymphoma; Ann Arbor stage IVA: Standard lymphoma staging system; IPI: International Prognostic Index.

Table 2 Treatment response of lymphoma with tumor thrombus reported in the literature

Ref.	Primary tumor site	Tumor thrombus site	Pathology	Treatment	Prognosis
Wagner et al[17], 1993	Right kidney	Renal vein and IVC	DLBCL	Right radical nephrectomy followed by 6 courses of CHOP chemotherapy	Significant mass reduction after 1 year
Yoneyama et al[24], 1998	Hepatic tumor of the left and caudate lobes	Portal vein	DLBCL	Left hepatic trisegmentectomy, caudate lobectomy and portal tumour thrombectomy followed by 6 courses of combination chemotherapy including CHOP and VP-16	4.5 years without recurrence after surgery
Matsumoto et al[37], 2004	Mesentery nodal	Portal vein and superior mesenteric vein	DLBCL	An open surgical biopsy followed by 7 courses of CHOP	7.5 years without recurrence after diagnosis
Hiraga et al[38], 2006	Porta hepatis	Portal vein	DLBCL	Biopsy followed by 8 courses of THP-COP	6 years without recurrence after the initial diagnosis
Natsuizaka et al[28], 2009	Liver and left spermatic cord	Portal vein	DLBCL	Percutaneous liver biopsy and left testis and spermatic cord were surgically resected followed by 6 courses of R-CHOP	Complete response maintained for 16 months after chemotherapy
Samlowski et al[39], 2011	Right upper pole of kidney, right adrenal gland and liver	Renal vein and IVC	DLBCL	Biopsy followed by R-CHOP	Partial response after 3 courses of chemotherapy
Chen et al[25], 2013	Left solid renal mass, retroperitoneal extension and adenopathy	Renal vein, IVC	DLBCL	Biopsy followed by R-CHOP	Complete response maintained for 47 months

IVC: Inferior vena cava; DLBCL: Diffuse large B-cell lymphoma; CHOP: Cyclophosphamide, doxorubicin, vincristine, and prednisone; THP-COP: Cyclophosphamide, pirarubicin, vincristine, and prednisone; R-CHOP: Cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab.