Testicular plasmacytoma

Clinical History

A 52-year-old man treated to our hospital for multiple myeloma complained of left scrotal painful swelling.

Imaging Findings

A 52-year-old man presented to our hospital complaining of left scrotal painful swelling. The patient was diagnosed with multiple myeloma two years ago and he had been under proper treatment ever since. Physical examination revealed an enlargement of the left testis and the patient was referred to our department for ultrasound examination. Ultrasonography confirmed the presence of a left testicular mass with a heterogenous predominantly hypo-echogenic pattern. Prominent blood supply was also present. The suspicion of plasmacytoma arose because of the clinical history but the possibility of another testicular malignancy could not be excluded. Left orchiectomy was performed under the diagnosis of malignant testicular tumor.Histologically mature plasma cells with peripheral round nuclei and basophilic cytoplasm were found thus leading to the diagnosis of testicular plasmacytoma.

Discussion

Plasmacytomas of the testis are neoplasias that may occur in concomitance with generalized multiple myeloma. Extraskeletal involvement of the testis during multiple myeloma is a rare disease; primary extraosseus myeloma of the testis is even more unusual, and shows progression to typical multiple myeloma after orchiectomy in most cases.Extramedullary plasmacytomas may involve a wide variety of anatomic sites, the most frequent being the respiratory or the gastrointestinal tract as well as lymph nodes and soft tissues. Only occasionally do patients present with testicular or ovarian localizations or with skin infiltrative lesions.Testicular plasmacytomas are assumed to have an incidence ranging between 0.03% and 0.1% of all primary and secondary tumors of the testis [7,29]. If we only consider patients with multiple myeloma, the incidence of plasmacytoma infiltrating the testis ranges between 0.6 and 2.7% of the total. Ultrasound findings are not specific Usually an hypoechogenic mass is revealed, similar to any other testicular malignancy. Immunoperoxidase staining on plasmacytomas with testicular involvement reveals an incidence of IgG, IgA, IgD, and light chains of 20%, 46.7%, 6.6%, and 26.7%, respectively. This represent a different distribution as compared to those reported among patients with classical multiple myeloma, where IgA occurs in only 25% of the total cases.

Differential Diagnosis List

Final Diagnosis

Secondary plasmacytoma of the testis.

URL:	https://www.eurorad.org/case/5384
DOI:	10.1594/EURORAD/CASE.5384
ISSN:	1563-4086