Primary Diffuse Large B-cell Lymphoma Of Testis Involving The Skin:one Case Report And Literature Review

Purpose: Diffuse large B-cell lymphoma(DLBCL) belongs to the largest subgroup of non-Hodgkin lymphoma(NHL), about half of the total non-Hodgkin lymphoma, and it is also the most kind of the extranodal lymphomas. The gastrointestinal tract is involved in the first of the extranodal lymphomas. Other parts such as waldeyer, skin and central nervous, etc. can occur as well. Primary diffuse large B-cell lymphoma of testis is not a common disease in the clinical. Its clinical characteristic : it is common to occur in the old man over the age of 50, testicular painless swelling and scrotal heaviness is the main performance, and it is high degree of malignant, spread the whole body fast, poor prognosis. According to the literature, primary diffuse large B-cell lymphoma of testis is not only easy to involve central nervous system and skin, but also point out with poor prognosis. The performance involving the skin is the skin uplift in papillary, nodules or plaques with different size and the skin lesions also have different form, can be for solid or ucler. This article, to report one case report of patients with primary diffuse large B-cell lymphoma of testis involving the skin, through to its clinical manifestation, laboratory examination, imaging examination and histopathology results, relevant treatment and prognosis, has a systematic analysis and research.Case presentation: A 74-year-old male patient is in hospital on December 12, 2013 because of right lower limb dark red plaques with mild itchy two month ago. Two months ago, the patient inadvertently found there were several red plaques on right lower limb, broad bean size, no mild itchy or pain and discomfort, statistically insignificant. Then plaques increased gradually in number and quantity, some of them have the trend to fuse. The patient was admitted to other hospital on September,2013 duo to right side testis painless swelling four months, was diagnosed with right side testicular tumors and have the right testis radical resection. Postoperative pathology showed(right testis) diffuse large B-cell lymphoma, involving epididymis. Chemotherapy with B-COP(B : bleomycin、C: cyclophosphamidum、O:leurocristine、P:prednison)one week. High blood pressure more than 20 years. Dermatologist check: there are several dark red plaques and nodules on right lower limb, different size, a smooth surface, no hard, no tenderness, the base having invasion trend, part of the fusion, no burst, lower limbs without edema. Skin histopathological examination: dermis and subcutaneous diffuse large lymphcell invasion, not infringe upon the epidermis.Immunohistochemicalexamtion:CD20(+),CD79a(+),Bcl-2(+),CD10(+),Mum1(+),ki-67>90(+),Bcl-6(-),CD3(-),CD30(-), immunohistochemical mark non-Hodgkin lymphoma(come from B-cell), fit diffuse large B-cell lymphoma. Diagnosis: primary diffuse large B-cell lymphoma of the right testis involving the skin. Rashs disappeared after chemotherapy with R-CHOP( R: rituximab 、 C: cyclophosphamidum 、 H :doxorubicin、O:leurocristine、P:prednison).Conclusion: The patient found right lower limb rashs after being diagnosised primary diffuse large B-cell lymphoma of the right testis, and this disease is easy to involve the skin, need heightened alertness about the possibility of primary diffuse large B-cell lymphoma of testis involving the skin. The dermatologist check and Immunohistochemical examtion are the gold standard of diagnosis of the disease. On the treatment, using the classic solution R-CHOP can be result in good effects.