|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 680-681
Secondary plasmacytoma of the testis with hydrocele: A rare case report
C Gururajaprasad, Sunila, M Rangaswamy, GV Manjunath
Department of Pathology, JSS Medical College, JSS University, Mysore, India
|Date of Web Publication||10-Mar-2016|
Department of Pathology, JSS Medical College, JSS University
Source of Support: None, Conflict of Interest: None
|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
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.
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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The testicular malignancies show a bimodal distribution, with the first peak between 15 and 30 years and the second after 50 years. 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.
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.
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.
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[Figure 1], [Figure 2]