Primary Diffuse Large B-Cell Lymphoma of the Prostate: A Rare Diagnostic Challenge

Abstract

Primary prostatic lymphoma is a rare extranodal manifestation of Non-Hodgkin Lymphoma, accounting for <0.1% of prostate malignancies and ~0.1% of lymphomas. The most common subtype is Diffuse Large B-Cell Lymphoma benign prostatic hyperplasia or carcinoma due to nonspecific lower urinary tract symptoms, leading to frequent misdiagnosis. Serum prostate-specific antigen (PSA) is usually normal, which can provide an important diagnostic clue. Early diagnosis is essential as management differs significantly from prostate carcinoma. A 84-year-old male with comorbidities: Hypertension, cerebrovascular disease, coronary artery disease, Parkinsonism. His presentations were history of Acute urinary retention 1 month back,  increased frequency of urination for 1 month, nocturia for the same duration, history of weight loss and anorexia for 2 months were PSA was Within normal range. Histopathology: Consistent with Diffuse Large B-Cell Lymphoma management treated with R-CHOP chemotherapy, good tolerance to treatment Outcome. Primary prostatic lymphoma is a rare but significant differential diagnosis in patients with prostatic enlargement. An enlarged prostate with normal PSA levels should raise suspicion for lymphoma. Definitive diagnosis depends on histopathology along with immunohistochemistry. RCHOP chemotherapy remains the cornerstone of treatment. Early recognition and diagnosis are essential to improve outcomes and avoid inappropriate management.

Bangladesh J Medicine  2026; Vol. 37, No. 2(1): pp.  243