Primary Testicular Lymphoma Involving the Spermatic Cord and Gonadal Vein

We report a case of a 70-year-old man with a history of prostatic adenocarcinoma and a 3-month history of right hemiscrotal swelling. The patient underwent a CT scan, scrotal ultrasound, and F-18 FDG-PET scan to evaluate for metastatic prostate cancer. The CT scan demonstrated an ill-defined soft-tissue mass extending along the right gonadal vein. Scrotal ultrasound revealed a heterogeneous right testicular mass. The F-18 FDG-PET scan demonstrated intense hypermetabolic activity along the course of the right gonadal vein extending to the right hemiscrotum. Subsequent right radical orchiectomy and pathologic examination revealed a B-cell lymphoma, infiltrating the testicular parenchyma, spermatic cord, gonadal vessels, and adjacent soft-tissues. Lymphoma or other tumors rarely infiltrate the spermatic cord, and have only very rarely been demonstrated on PET imaging.