PMC10267869_01
Computed tomography (CT) images of primary right testicular NK/T-cell lymphoma. (A) The transverse image showed a mass with increased density (32 HU) in the right testis. (B) The arterial phase transverse image showed patchy increased enhancement (54 HU), and multiple trophoblastic vessels in the tumor. (C, D) Venous phase transverse image and coronal images showed uneven moderate enhancement of tumor (66 HU), interrupted continuity of the local envelope.
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Further enhancement computed tomography (CT) examination revealed a mass with increased density (32 HU) in the right testis (Figure 1A). The mass showed patchy increased enhancement, interrupted continuity of the local envelope, and multiple trophoblastic vessels in the arterial phase (Figure 1B). The CT attenuation values in the arterial and venous phases were 54 and 66 HU, respectively (Figures 1C, D).
Histopathological and immunohistochemical images. (A) Hematoxylin-eosin (HE) staining (magnification x40 & 200) showed a large number of diffusely infiltrating tumor cells among the germinal tubules. The cells with abundant cytoplasm showed different sizes, large deep-stained nuclei, and easily visible nuclear schizophrenia. Immunohistochemistry showed that the short spindle cells were positive for CD3 (B), CD20 (C), CD43 (D), CD56 (E), EBER (F), granzyme B (G), TIA-1 (H). Ki-67 was observed to be positive in 80% of the tumor cells (I) (magnification x40 & 200).
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Coagulative necrosis was found inside with inflammatory cell infiltration around the necrotic area (Figure 2A). Immunohistochemistry showed positive expression of EBER, CD3, CD30, CD20, CD43, CD56, T-cell intracellular antigen 1 (TIA-1), granzyme B (Figures 2B-H). Ki-67 was observed to be positive in 80% of the tumor cells (Figure 2I).
18F-FDG PET/CT images of primary right testicular NK/T-cell lymphoma. (A) The anteroposterior 3-dimensional maximum intensity projection image (MIP) demonstrated elevated metabolism in the left testicular, and right inguinal lymph nodes. (B) The transverse images showed a missing right testis and FDG-avid circular soft tissue in the right scrotum (SUVmax = 3.9), relating to post-operative changes. (C) The transverse images showed the left testicle was enlarged at a maximum dimension of about 3.9 cm x 6.0 cm and had a significantly high FDG uptake (SUVmax = 9.7). (D) The transverse images showed a swelling right inguinal lymph node (1.3 cm x 2.1 cm) had an increased FDG uptake (SUVmax = 6.8). (E-G) The transverse images showed a soft tissue mass with unevenly increased FDG uptake found in the bilateral nasal cavity, inferior turbinates, and left septal sinus (SUVmax = 24.5), suggesting lymphoma involvement.
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Meanwhile, a soft tissue mass with unevenly increased FDG uptake was found in the bilateral nasal cavity, inferior turbinates, and left septal sinus (SUVmax = 24.5), suggesting lymphoma involvement (Figure 3).
PMC10267869_02
Magnetic resonance images (MRI) and CT images of primary right testicular NK/T-cell lymphoma (A-F). (A) T1WI transverse image shows an increase in the size of the right testicle with a heterogeneous low signal lesion. (B) T2WI transverse image shows a heterogeneous high signal lesion. The lesions showed a high signal on DWI (C) and a low signal on ADC images (D). (E, F) The transverse image and coronal images of the lung window on CT showed multiple high-density nodules in different sizes in both lungs with the largest one at 3.0 cm x 1.8 cm in size in the lower lobe of the left lung, suggesting lung metastasis. Histopathological and immunohistochemical images (G-L). (G) Hematoxylin-eosin (HE) staining (magnification x40 & 200) showed diffuse infiltration of tumor cells into the testicular parenchyma and diffuse growth of lymph-like cells between the germinal tubules with varying sizes and nuclear schizophrenia. Immunohistochemistry showed that the short spindle cells were positive for CD3 (H), CD8 (I), granzyme B (J), and TIA-1 (K). Ki-67 was observed to be positive in 70% of the tumor cells (L) (magnification x40 & 200).
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While an abnormal signal was seen in the right epididymal area (Figures 4A-D). CT examination further showed multiple high-density nodules of different sizes in both lungs with the largest one at 3.0 cm x 1.8 cm in size in the lower lobe of the left lung, suggesting lung metastasis (Figures 4E, F). Necrosis can also be partly seen and atrophy of the residual testicular tissue was found (Figure 4G). Immunohistochemistry showed positive expression of CK, CD3, CD8, TIA-1, CD30 (focal), EMA (focal), and granzyme B (Figures 4H-K), but the negative expression of CD20, CD5, CD4, and EBNA2. Ki67 was observed to be positive in 70% of the tumor cells (Figure 4L).