Adult paratesticular tumours

Our plain-English summary of Adult paratesticular tumours, by B. Khoubehi, V. Mishra, M. Ali, et al (BJU International, 2002).

The study

• Authors: B. Khoubehi, V. Mishra, M. Ali, H. Motiwala, O. Karim
• Journal: BJU International
• Published: 2002;90(7):707-15
• Type of article: Review
• Cited by: 123 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This review article, from the Department of Urology at Wexham Park Hospital, described benign and malignant tumours of the adult paratesticular region, which includes the spermatic cord, testicular tunics, epididymis and vestigial remnants. The authors drew on published series and case reports. They noted estimates that 70% of paratesticular tumours are benign and 30% malignant, and that the spermatic cord is thought to be the site of origin in 90%. The commonest benign tumours were lipomas, adenomatoid tumours and leiomyomas. Benign tumours were described as amenable to surgical resection, with follow-up advised for some. Among published sarcoma series, leiomyosarcoma (32%), rhabdomyosarcoma (24%) and liposarcoma (20%) were the commonest subtypes, and malignant fibrous histiocytoma accounted for about 13%. The authors' institution, serving 450 000 people, had five paratesticular sarcomas in 3 years. The review reported a general consensus that adult paratesticular sarcomas should be treated by complete resection with high ligation of the spermatic cord. The roles of retroperitoneal lymph node dissection and adjuvant chemotherapy were described as controversial. Reported 5-year disease-specific survival was 58–80%. Malignant mesothelioma was described as the commonest paratesticular malignancy with an epithelial growth pattern, with asbestos exposure the only known risk factor. Local recurrence was 36% after local resection of the hydrocele wall and 10.5–11.5% after orchidectomy. About 40% of patients died of the disease, with a median survival of 24 months. Other rare malignant and metastatic tumours were also summarised.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a narrative review of benign and malignant tumours in adults that arise in the tissues around the testis (the paratesticular region). It drew on previously published reports and did not report a new study of asbestos exposure. The authors described malignant mesothelioma as the commonest paratesticular malignancy with an epithelial growth pattern. It usually arises in the tunica vaginalis, with peak incidence at ages 55 to 75. Citing earlier work, they stated that exposure to asbestos is the only known risk factor for it. They also stated that well-differentiated papillary mesothelioma of the tunica vaginalis is not associated with asbestos exposure. Summarising published series, they reported that about 52% of patients with paratesticular malignant mesothelioma developed local recurrence or metastasis, and about 40% died of the disease, with a median survival of 24 months. The authors called it an aggressive tumour and wrote that radical inguinal orchidectomy seems to be the optimum treatment. They noted that follow-up in the published series was often short and variable.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature on adult paratesticular tumours
• Who was studied: No study population of its own. The review covered published reports on benign and malignant paratesticular tumours in adults. It also briefly mentioned 5 paratesticular sarcomas seen at the authors' institution (Department of Urology, Wexham Park Hospital) over 3 years.
• Exposure: Asbestos was not studied directly. The review stated, citing earlier work, that asbestos exposure is the only known risk factor for malignant mesothelioma. No fiber types were named.
• Main results:
  • Citing earlier work, the authors stated that about 70% of paratesticular tumours are benign and 30% are malignant.
  • Malignant mesothelioma of the paratesticular region most often arises in the tunica vaginalis, with peak incidence in people aged 55 to 75 years.
  • Well-differentiated papillary mesothelioma of the tunica vaginalis, a mostly benign tumour, was described as not associated with asbestos exposure.
  • In published reports on paratesticular malignant mesothelioma, local resection of the hydrocele wall was associated with a local recurrence rate of 36%. Local recurrence after orchidectomy was reported in 10.5 to 11.5% of patients.
  • Across published series of paratesticular malignant mesothelioma, about 52% of patients developed local recurrence or metastasis.
  • Across published series of paratesticular malignant mesothelioma, about 40% of patients died from the disease, with a median survival of 24 months.
  • In malignant mesothelioma, age under 60 years and organ-confined disease at diagnosis were the variables reported to have a statistically significant correlation with survival.
• The authors' conclusion: The authors described paratesticular malignant mesothelioma as an aggressive tumour with high recurrence and mortality rates. They wrote that radical inguinal orchidectomy seems to be the optimum treatment for it.
• Limitations the authors state:
  • Follow-up in the published series of malignant mesothelioma was often short and variable.
  • The role of adjuvant (additional) treatment in malignant mesothelioma had not been fully assessed.
  • Evidence on treating paratesticular sarcomas came from small numbers of patients in retrospective, heterogeneous studies.

Topics

Medical terms in this study, explained in our Lexicon: Paratesticular, Spermatic Cord, Epididymis, Adenomatoid Tumor, Surgical Resection, Sarcoma, Paratesticular Sarcoma, Retroperitoneal Lymph Node Dissection (RPLND).

Related studies

• Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India — P.A.M. Paul, N. Calton, et al. (2021)
• Paratesticular mesothelioma. Report of a case with comprehensive review of literature — M. Bisceglia, D.B. Dor, et al. (2010)
• Paratesticular malignant mesothelioma associated with abdominoscrotal hydrocele — A.L. Velasco, J. Ophoven, et al. (1988)
• Paratesticular papillary mesothelioma — R. Linn, B. Moskovitz, et al. (1988)
• Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA — S.J. Lowry, N.S. Weiss (2016)
• Immunohistochemical profile of paratesticular serous papillary adenocarcinoma and tunica vaginalis facilitates distinction from malignant mesothelioma — P.R. Anchala, R. Dhir, et al. (2011)

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