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  Table of Contents  
LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 4  |  Page : 680-681
 

Secondary plasmacytoma of the testis with hydrocele: A rare case report


Department of Pathology, JSS Medical College, JSS University, Mysore, India

Date of Web Publication10-Mar-2016

Correspondence Address:
C Gururajaprasad
Department of Pathology, JSS Medical College, JSS University
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.178385

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How to cite this article:
Gururajaprasad C, Sunila, Rangaswamy M, Manjunath G V. Secondary plasmacytoma of the testis with hydrocele: A rare case report. Indian J Cancer 2015;52:680-1

How to cite this URL:
Gururajaprasad C, Sunila, Rangaswamy M, Manjunath G V. Secondary plasmacytoma of the testis with hydrocele: A rare case report. Indian J Cancer [serial online] 2015 [cited 2019 Dec 9];52:680-1. Available from: http://www.indianjcancer.com/text.asp?2015/52/4/680/178385


Sir,

Extramedullary plasmacytomas are rare. Testicular plasmacytomas are reported in less than 2% of the cases and are considered to be the local manifestations of a systemic plasma cell disorder rather than a primary neoplasm.[1]

A 70-year-old man presented with a painless testicular swelling of one month duration. It was gradually increasing in size. There was no history of trauma. Six months prior, the patient had a pathological fracture of the lower end of the left femur and the histopathological examination of the biopsy was reported as plasmacytoma. Local examination showed a nontender left testicular enlargement, with positive translucency. Hydrocele was present. A general examination showed no abnormal findings. All the hematological investigations were normal except for an erythrocyte sedimentation rate (ESR) of 70 mm/ first hour. Left orchidectomy was done with a clinical diagnosis of 'a testicular tumor with secondary hydrocele'. Gross examination showed an orchidectomy specimen ms 11 × 8 × 4 cm. The cut surface was grayish white and homogeneous, with intact tunica.

The histopathological study showed a tumor with cells arranged in sheets and cords in the testicular interstitium, sparing the seminiferous tubules. The cells were uniform with eosinophilic cytoplasm, round and eccentric nuclei, and prominent nucleoli [Figure 1] and [Figure 2]. Immunohistochemistry showed that the tumor cells were positive for CD138 and epithelial membrane antigen (EMA) and negative for CD20 and leukocyte common antigen (LCA). Kappa light chain restriction was noted. A final diagnosis of plasmacytoma was made.
Figure 1: Plasma cell infiltration sparing the seminiferous tubules (H and E, ×100)

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Figure 2: Plasma cells infiltrating the testis (H and E, ×100)

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The testicular malignancies show a bimodal distribution, with the first peak between 15 and 30 years and the second after 50 years.[2] Primary germ cell neoplasms are common in the first group and lymphomas are common in the second. Painless testicular swelling is the most common complaint and hydrocele has been found in only two cases.[3]

The prognosis of patients with testicular plasmacytoma and multiple myeloma is poor with a survival from 5 weeks to 48 months. The standard treatment is radical orchidectomy. Chemotherapy and radiation have not been successful and some patients have lived without the plasma cell disorder.[4]

A painless testicular swelling in an elderly male must arouse a high index of suspicion of a plasmacytoma. It is important in such cases to make an extensive search for the evidence of multiple myeloma, to differentiate the primary plasmacytoma of the testis from secondary plasmacytoma. This has great therapeutic and prognostic implications.

We present this case for its rarity - secondary plasmacytoma with hydrocele- and to emphasize the importance of a thorough evaluation and follow-up of such cases, and to categorize the testicular plasmacytoma as a secondary or primary.

 
  References Top

1.
Alvarez-Múgica M, JalónMonzón A, BulnesVázquez V, Aguilar Andrea C, Fernández Gómez JM, González Alvarez RC, et al. Secondary testicular plasmocytoma. Arch Esp Urol 2007,6099-102.  Back to cited text no. 1
    
2.
Nicholas CR, Timmerman R, Foster RS: Neoplasms of testis. 5th ed. Cancer Medicine. In: Blast RC, Gansler TS, Holland JF, Frei E, American Cancer Society, editors, cancer Medicine, 5th Ed., BcDecaer: Lewinston, NY; 2000.p. 1596-1621.  Back to cited text no. 2
    
3.
Tomoko S, Takashi K, Tohru A. A case of a extramedullary plasmacytoma of the testis diagnosed cytologically by scrotocentesis. J. Jpn Soc, Clin Cytol, 1995;34:1156-9.  Back to cited text no. 3
    
4.
Anghel G, Petti N, Remotti D, Ruscioc C, Blandino F, Majolino I, Testicular plasmacytoma: Report of a case and review of literature. Am J Hematol 2002;71:98-104.  Back to cited text no. 4
    


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