Bilateral Primary Testicular Lymphoma with Retroperitoneal and Possible CNS Involvement: A Rare Case Report

Primary testicular lymphoma (PTL) is a rare, aggressive extranodal non-Hodgkin’s lymphoma, most commonly affecting older men. Bilateral testicular involvement is particularly uncommon and indicates a poorer prognosis. We report the case of a 58-year-old male presenting with bilateral scrotal swelling, systemic symptoms, and significant retroperitoneal lymphadenopathy. Imaging revealed a lobulated retroperitoneal mass encasing major vessels and bilateral testicular enlargement with necrosis. Bilateral orchiectomy followed by histopathology confirmed diffuse large B-cell lymphoma, nongerminal center type. FDG PET-CT showed extensive nodal involvement and intense uptake in the third ventricle, suggestive of possible central nervous system (CNS) dissemination. The disease was staged as Ann Arbor stage IV, and the patient was referred for systemic chemotherapy with CNS-directed prophylaxis. This case underscores the importance of early recognition, multimodal imaging, and histopathological confirmation in diagnosing PTL and highlights the need for CNS surveillance and multidisciplinary management in advanced presentations.