Yeungnam Univ J Med.  2021 Jul;38(3):231-234. 10.12701/yujm.2020.00675.

Metachronous extranodal natural killer/T-cell lymphoma of nasal type and primary testicular lymphoma

• Maeng YI
• Lee SJ

• KMID: 2518665
• DOI: http://doi.org/10.12701/yujm.2020.00675

Abstract

We report a rare case of metachronous lymphoma with two distinct cell lineages in a 75-year-old man. The patient complained about having nasal obstruction for 2 years and extranodal natural killer (NK)/T-cell lymphoma of the nasal type was diagnosed from a biopsy. The immunohistochemical staining for CD56 and in situ hybridization for Epstein-Barr virus (EBV)–encoded small RNA (EBER-ISH) were positive and the tumor cells were negative for CD20. After 13 months of concurrent chemoradiotherapy, the patient presented with swelling of the left testis. Positron emission tomography scan detected an abnormal uptake in the testis. A diffuse large B-cell lymphoma, not otherwise specified, was diagnosed from subsequent radical orchiectomy. The immunohistochemical staining revealed to be positive for CD20, BCL2, BCL6, and MYC and negative for CD10 and EBER-ISH.

Keyword

Diffuse large B-cell lymphoma; Extranodal NK-T-cell lymphoma; Lymphoma; Nasal type; Primary testicular lymphoma

Figure

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  Fig. 1. Histologic and immunohistochemical findings. (A) Diffuse infiltration of small-to-medium–sized lymphoid cells is observed (hematoxylin and eosin stain, ×400). (B) Tumor cells are positive for CD56 (immunohistochemical stain, ×400). (C) Tumor cells are positive for Epstein-Barr virus (EBV) (in situ hybridization for EBV–encoded small RNA, ×400). (D) Tumor cells are negative for CD20 (immunohistochemical stain, ×400).

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  Fig. 2. Histologic and immunohistochemical findings of the left testis. (A) Microscopic findings show a diffuse proliferation of large lymphoid cells (hematoxylin and eosin stain, ×400). (B) Tumor cells are positive for CD20 (immunohistochemical stain, ×400). (C) Tumor cells are negative for CD56 (immunohistochemical stain, ×400). (D) Tumor cells are negative for Epstein-Barr virus (EBV) (in situ hybridization for Epstein-Barr virus–encoded small RNA, ×400).

Reference

References

1. Møller MB, d'Amore F, Christensen BE; Danish Lymphoma Study Group. Testicular lymphoma: a population-based study of incidence, clinicopathological correlations and prognosis. Eur J Cancer. 1994; 30:1760–4.

2. Chan JK, Quintanilla-Martinez L, Ferry JA. Extrannodal NK/T-cell lymphoma, nasal type. In : Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press;2017. p. 368–71.

3. Pileri SA, Weisenburger DD, Sng I, Nakamura S, Muller-Hermelink HK, Chan WC, et al. Peripheral T-cell lymphoma, NOS. In : Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, editors. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press;2017. p. 403–6.

4. King RL, Goodlad JR, Calaminici M, Dotlic S, Montes-Moreno S, Oschlies I, et al. Lymphomas arising in immune-privileged sites: insights into biology, diagnosis, and pathogenesis. Virchows Arch. 2020; 476:647–65.

5. Booman M, Douwes J, Glas AM, de Jong D, Schuuring E, Kluin PM. Primary testicular diffuse large B-cell lymphomas have activated B-cell-like subtype characteristics. J Pathol. 2006; 210:163–71.

6. Cheah CY, Wirth A, Seymour JF. Primary testicular lymphoma. Blood. 2014; 123:486–93.

7. Brunn A, Nagel I, Montesinos-Rongen M, Klapper W, Vater I, Paulus W, et al. Frequent triple-hit expression of MYC, BCL2, and BCL6 in primary lymphoma of the central nervous system and absence of a favorable MYC(low)BCL2 (low) subgroup may underlie the inferior prognosis as compared to systemic diffuse large B cell lymphomas. Acta Neuropathol. 2013; 126:603–5.

8. Fonseca R, Habermann TM, Colgan JP, O'Neill BP, White WL, Witzig TE, et al. Testicular lymphoma is associated with a high incidence of extranodal recurrence. Cancer. 2000; 88:154–61.