title: Testicular ischemia due to intravascular large B-cell lymphoma: a novel presentation in an immunosuppressed individual.
abstract: A 56-year-old man presented with fever, disorientation, and testicular pain. He was receiving azathioprine immunosuppression for autoimmune hepatitis. Orchiectomy identified occlusion of spermatic cord vessels by intravascular large B-cell lymphoma (IVLBL) and ischemic changes in the testis. Tumor cells were positive for CD 10, CD 20, CD 30, and Epstein-Barr virus (EBV) latent membrane protein 1 (LMP-1) and early region RNA (EBER). He was treated with the cessation of azathioprine, chemotherapy, anti-CD 20 immunotherapy, and radiotherapy. Twenty months after diagnosis, he is alive with no evidence of lymphoma or hepatitis. This is the first report of IVLBL presenting with testicular ischemia. It highlights the importance of prompt diagnosis and intervention to achieve durable response. That this lymphoma arose in the setting of immunosuppressive therapy introduces additional complexity relating to pathogenesis, clinical behavior, and treatment.
authors: Wayne State University School of Medicine, Detroit, MI 48201, USA.
authors: Paul
authors: P
authors: Tranchida
authors: Michael
authors: M
authors: Bayerl
authors: Mary Jo
authors: MJ
authors: Voelpel
authors: Margarita
authors: M
authors: Palutke
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000503:physiopathology; D005334:Fever / Q000209:etiology; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017403:In Situ Hybridization; D007511:Ischemia / Q000209:etiology*; D016393:Lymphoma, B-Cell / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011878:Radiotherapy; D000069283:Rituximab; D013085:Spermatic Cord / Q000098:blood supply / Q000473:pathology; D013733:Testicular Diseases / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D014412:Tumor Virus Infections / Q000503:physiopathology; D019043:Vascular Neoplasms / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D014750:Vincristine / Q000627:therapeutic use; D014763:Viral Matrix Proteins / Q000378:metabolism
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; C037662:EBV-associated membrane antigen, Epstein-Barr virus; D007166:Immunosuppressive Agents; D014763:Viral Matrix Proteins; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D001379:Azathioprine; D011241:Prednisone