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High grade non-germinal centre-like diffuse large B-cell lymphoma double expressor presenting as a hydrocoele
  1. Donnacha Hogan1,
  2. Brian Hayes2,
  3. Clodagh Keohane3 and
  4. Derek Barrry Hennessey1
  1. 1Department of Urology, Mercy University Hospital, Cork, Ireland
  2. 2Department of Histopathology, Cork University Hospital, Cork, Ireland
  3. 3Department of Haematology, Mercy University Hospital, Cork, Ireland
  1. Correspondence to Dr Donnacha Hogan; donnacha.hogan{at}umail.ucc.ie

Abstract

A 72-year-old man was referred to our urology outpatient department with a left hemi-scrotal swelling increasing in size over a matter of weeks, initially suspicious for a left hydrocoele. Initial investigation with ultrasound (US) identified a heterogenous enlargement of the left testis and epididymis with a soft tissue mass extending through the inguinal canal. Subsequent CT detected this soft tissue mass to extend along the left gonadal vein to the level of the left renal vein. A biopsy of the retroperitoneal mass confirmed a diagnosis of diffuse large B-cell lymphoma. Immunohistochemical staining further categorised this lymphoma as double expressor but not double hit.

Through multidisciplinary team involvement the patient was treated with combination steroids and chemotherapy. Given the scrotal involvement this was considered a sanctuary site for chemotherapy therefore the patient also received radiotherapy to the scrotum. He recovered well following his treatment. This case highlights how early specialist referral can identify rare variants of disease. Essential preoperative imaging with US prior to treating a presumed hydrocoele prevented inappropriate surgical excision. A multidisciplinary team approach improved the patient’s outcome and is hoped to have improved his chances of recurrence-free survival.

  • urology
  • haematology (incl blood transfusion)
  • malignant and benign haematology
  • pathology
  • radiology

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Footnotes

  • Twitter @HoganDonnacha

  • Contributors DBH identified the case and was involved in conception of the manuscript planning. DH consented the patient and wrote the first draft of the manuscript. BH was involved in writing the investigation and discussion section of the manuscript. CK was involved in writing the treatment and discussion section of the manuscript. All authors have reviewed and approved the final draft of the manuscript submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.