Interesting ImagesUnusual Extramedullary Manifestation in Multiple Myeloma Bilateral Synchronous Testicular InfiltrationStrauss, Dimitrios∗; Sachpekidis, Christos MD∗; Dapunt, Ulrike MD†; Goldschmidt, Hartmut MD†; Dimitrakopoulou-Strauss, Antonia MD∗ Author Information From the ∗Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center †Medizinische Klinik V, Universitätsklinikum Heidelberg and Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany. Received for publication May 20, 2022; revision accepted October 15, 2022. Conflicts of interest and sources of funding: none declared. Contributorship: All authors contributed to the study conception and design. The first draft of the manuscript was written by D.S., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Correspondence to: Dimitrios Strauss, Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, D-69210 Heidelberg, Germany. E-mail: [email protected]. Clinical Nuclear Medicine 48(2):p e76-e77, February 2023. | DOI: 10.1097/RLU.0000000000004496 Buy Metrics Abstract A 73-year-old man with multiple myeloma (initial diagnosis 21 months earlier) was referred to our center for a whole-body 18F-FDG PET/CT. We detected a bilateral synchronous testicular manifestation, which was confirmed by histopathology after orchiectomy. Besides hypermetabolic lesions in the spine and ribs (most likely old fractures), known osteolysis showed no uptake. Extramedullary manifestation occurs in 13% to 20% of cases, among these 4% demonstrate testicular manifestation, which is associated with poor survival rates. Optimal therapy management is still unclear, due to limited data. To the authors’ knowledge, so far only 3 comparable cases have been described. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.