Various neurological symptoms by neurolymphomatosis as the initial presentation of primary testicular lymphoma

Abstract

Neurological symptoms induced by the infiltration of malignant lymphoma into the nervous systems are subsumed under the term neurolymphomatosis (NL). Here, we report the case of a 30-year-old Japanese man with primary testicular lymphoma complicated, as seen in various neurological findings, by secondary NL prior to testicular swelling. Painless right scrotal enlargement was noticed more than 1 month after the appearance of neurological complications such as right upper extremity numbness, dysarthria, facial palsy, and diplopia. Proactive investigation and biopsies of extranodal sites at high risk of central nervous system infiltration of malignant lymphoma, such as the testes, should be considered when secondary NL is suspected based on imaging findings.

Keywords: Central nervous system infiltration; Diffuse large B-cell lymphoma; Neurolymphomatosis; Primary testicular lymphoma.

Fig. 1

MRI findings of the CNS. a, b Gadolinium-enhanced MRI of cervical spine showed swelling of the cervical 5/6 roots on day 14 (a) and the cauda equina on day 20 (b). c, d Brain MRI on day 21 detected gadolinium enhancement in the bilateral roots of the facial nerve (c transverse section, d coronal section).

Fig. 2

Pathological findings of the testis. a Histopathological examination detected diffuse infiltration of the right testis by large atypical lymphocytes (HE, ×400). b These cells were positive for CD20 (×400).