The impact of histopathologic diagnosis on the proper management of testis neoplasms.

BACKGROUND: A 45-year-old man underwent a right orchiectomy for a rapidly growing testicular mass. After histologic and imaging examinations the patient was diagnosed with stage I (T1N0M0) seminoma. Approximately 2 months after surgery the patient began to complain of abdominal pain and a CT scan revealed a bulky retroperitoneal mass. The patient did not receive the planned prophylactic radiotherapy and was treated with combined cisplatin, etoposide and bleomycin chemotherapy; after the completion of this treatment he achieved complete remission. Three years later, and while still undergoing follow-up, the patient developed multiple neurological motor deficits.

INVESTIGATIONS: Brain MRI and CT-guided biopsy.

DIAGNOSIS: Diffuse large B-cell lymphoma of the testis, relapsing in the central nervous system.

MANAGEMENT: High-dose methotrexate alone or in combination with high-dose cytarabine.