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PET CT and scrotal ultrasound
A 62-year-old man presented to his primary care physician with palpable right axillary lymphadenopathy. On physical examination, he was noted to have multiple skin and subcutaneous nodules on his trunk. A right axillary lymph node biopsy revealed diffuse large B cell lymphoma (DLBCL), which was confirmed on a shave biopsy from a skin lesion on his back. PET imaging revealed multiple avid lesions in the subcutaneous tissue (largest index lesion in the left gluteal area) and muscle deposits (largest in the left upper paraspinal muscle). A 3.7 × 2.6 cm lobulated and intensely hypermetabolic mass was noted in the left testicle. He then underwent a scrotal ultrasound that revealed a large right hydrocele as well as heterogeneous masses in the right testicle, left testicle, and left epididymis. His tumor markers (AFP, β-HCG) were within normal limits, and his lactate dehydrogenase was mildly elevated. ]
The patient was evaluated by medical oncology, which recommended orchiectomy followed by initiation of systemic therapy for stage IIIB DLBCL (mono- or bilateral testicular involvement with involvement of distant lymph nodes and/or extranodal sites). The patient underwent bilateral scrotal orchiectomies, the pathology of which revealed DLBCL, non-germinal center type.
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A 62-year-old man presented to his primary care physician with palpable right axillary lymphadenopathy. On physical examination, he was noted to have multiple skin and subcutaneous nodules on his trunk. A right axillary lymph node biopsy revealed diffuse large B cell lymphoma (DLBCL), which was confirmed on a shave biopsy from a skin lesion on his back. PET imaging revealed multiple avid lesions in the subcutaneous tissue (largest index lesion in the left gluteal area) and muscle deposits (largest in the left upper paraspinal muscle). A 3.7 × 2.6 cm lobulated and intensely hypermetabolic mass was noted in the left testicle. He then underwent a scrotal ultrasound that revealed a large right hydrocele as well as heterogeneous masses in the right testicle, left testicle, and left epididymis. His tumor markers (AFP, β-HCG) were within normal limits, and his lactate dehydrogenase was mildly elevated.
The patient was evaluated by medical oncology, which recommended orchiectomy followed by initiation of systemic therapy for stage IIIB DLBCL (mono- or bilateral testicular involvement with involvement of distant lymph nodes and/or extranodal sites). The patient underwent bilateral scrotal orchiectomies, the pathology of which revealed DLBCL, non-germinal center type.
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