Question
What could be a potential cause of scrotal swelling and ataxia in a 62-year-old patient?
| A. |
Glioblastoma multiforme
|
| B. |
Hodgkin lymphoma
|
| C. |
Non-Hodgkin lymphoma
|
| D. |
Non-seminomatous germ cell tumor
|
Show Answer
|
Correct Answer » C
Explanation
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|
The key clue is:
- Elderly male (62 years)
- Scrotal swelling/testicular mass
- Neurological symptoms such as ataxia
In elderly men, the most common testicular malignancy is:
Primary testicular lymphoma
And this is almost always:
Non-Hodgkin lymphoma (usually diffuse large B-cell lymphoma)
Primary testicular NHL:
- Occurs predominantly after 60 years
- Frequently spreads to the CNS
- CNS dissemination can produce:
- Ataxia
- Cranial neuropathies
- Altered mental status
Thus the combination strongly favors NHL.
C. Non-Hodgkin lymphoma
Features supporting NHL:
- Most common testicular tumor in elderly men
- Aggressive extranodal spread
- CNS involvement common
- Neurological manifestations such as ataxia may occur
Diffuse large B-cell lymphoma is the common histological subtype.
Why Other Options Are Incorrect
A. Glioblastoma multiforme
- May cause ataxia if cerebellar involvement exists.
- Does not explain scrotal swelling.
B. Hodgkin lymphoma
- Although paraneoplastic cerebellar degeneration is classically associated with Hodgkin lymphoma, testicular involvement is extremely rare.
- In a 62-year-old with scrotal swelling, NHL is far more likely.
D. Non-seminomatous germ cell tumor
- Typically occurs in younger men (15–35 years).
- Uncommon in elderly patients.
