Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register

Our plain-English summary of Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register, by L. Vimercati, D. Cavone, M.C. Delfino, et al (Environmental Health, 2019).

The study

• Authors: L. Vimercati, D. Cavone, M.C. Delfino, L. De Maria, A. Caputi, G.M. Ferri, G. Serio
• Journal: Environmental Health
• Published: 2019;18(1):78
• Type of article: Systematic review
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare disease with a poor prognosis. The diagnosis and management of these lesions are often difficult for pathologists, surgeons, oncologists and occupational physicians. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy except orchidectomy.

Methods: A systematic literature review was conducted among the articles published in the English literature on primary MMTVT. Moreover four cases from the Apulia mesothelioma register are reported here.

Results: Two hundred eighty-nine cases of MMTVT have been reported from 1943 to 2018. Overall asbestos exposure has been investigated only for 58% of all cases reported in this review, while in 41.8% this data are not available. Noteworthy is the fact that in many reports there is not an anamnestic reconstruction of any asbestos exposure. A history of direct occupational, environmental or familial asbestos exposure is found in 27.6% of the cases. The four cases from the Apulia mesothelioma register are all with ascertained occupational exposure to asbestos.

Conclusions: The true incidence of asbestos exposure in MMTVT is underestimated because of insufficient information reported in older literature. To establish a broad consensus on the causal relationship between asbestos and MMTVT in the scientific community its necessary to analyze the same variables in the epidemiological studies. In general it should be recommended that a positive history of exposure to asbestos or to asbestos-containing materials are at risk for the development of a MMTVT and should be monitored.

In plain English

This article combined a systematic review of published English-language reports of malignant mesothelioma of the tunica vaginalis testis (a rare cancer of the lining around the testis) with four cases from the Apulia (southern Italy) mesothelioma register. The authors found 289 cases in 165 articles published from 1943 to 2018. Asbestos exposure had been investigated for 58% of these cases. For 41.8% this information was not available. A history of direct occupational, environmental or familial asbestos exposure was found in 27.6% of cases (80 cases). Most tumours were epithelial (53.6%). Sixty-six patients died of disease progression, after an average survival of 24.2 months. The four Apulia patients were aged 63 to 78. They made up 0.3% of all mesothelioma cases in the regional register from 1993 to 2018. All four had occupational asbestos exposure, with a mean latency of 47.5 years. The authors concluded that analytical epidemiological studies are needed to reach broad scientific agreement on a causal relationship between asbestos and this cancer. They noted that older reports gave insufficient exposure information.

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: Systematic literature review of published case reports and case series, plus a case series of four patients from a regional mesothelioma register
• Who was studied: 289 cases of primary malignant mesothelioma of the tunica vaginalis testis described in 165 English-language articles published 1943 to 2018 (search cut-off December 15, 2018), plus 4 cases recorded by the Apulia mesothelioma register (southern Italy) from 1993 to 2018
• Exposure: Asbestos exposure: occupational, environmental, household, familial or hobby. Occupations in the reviewed cases included insulators, dock workers, steel industry workers, farmers and shipyard workers. No fiber types were named.
• Main results:
  • Among the 289 literature cases, asbestos exposure had been investigated for 58%. For 41.8% this information was not available.
  • Among the 289 literature cases, a history of direct occupational, environmental or familial asbestos exposure was found in 27.6% (80 cases).
  • Of the 80 exposed literature cases, 87.5% had a documented history of asbestos exposure; the remaining 12.5% reported generic occupational exposure.
  • Among the exposed literature cases, four had environmental exposure and six had household, family or hobby exposure. Five cases, with or without declared exposure, had pleural plaques or asbestos bodies.
  • Among the literature cases, the tumour type was epithelial in 53.6%, mixed biphasic in 15.5% and fibrous sarcomatoid in 1.7%.
  • Among the literature cases, 66 patients died of disease progression, with an average survival of 24.2 months (range 1 to 76).
  • Among the literature cases, the overall rate of recurrence or metastasis was 26.2%, mostly within the first 2 years of follow-up.
  • The Apulia register recorded 4 cases from 1993 to 2018. These were 0.3% of all malignant mesothelioma cases in the regional register over that period.
  • All four Apulia cases had ascertained occupational exposure to asbestos.
  • The four Apulia patients were aged 63 to 78 at diagnosis, with an average age of 73.2.
  • For the four Apulia cases, latency averaged 47.5 years (range 41 to 58). Duration of asbestos exposure averaged 10.5 years (range given as 2 to 21).
  • At last follow-up in September 2018, two of the four Apulia patients were alive and two were dead: one died of disease metastasis and one of heart disease.
• The authors' conclusion: The authors concluded that analytical epidemiological studies will be needed to establish broad scientific consensus on a causal relationship between asbestos and malignant mesothelioma of the tunica vaginalis testis. They stated that a case-control study using Italian national mesothelioma registry data was under way.
• Limitations the authors state:
  • The authors stated that data from the reviewed literature were often not comparable because of the long period it covered (1943 to 2018).
  • The authors stated that the true frequency of asbestos exposure in these cases is underestimated because older reports gave insufficient information.
  • The authors noted that many reports did not reconstruct the patient's history of asbestos exposure.
  • The authors noted that poor patient recall may have affected the reconstruction of exposure and work histories.
  • The review included only English-language literature.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Mesothelioma, Tunica Vaginalis, Systematic Review, Prognosis, Occupational Exposure, Asbestos-Containing Material (ACM).

Related studies

• Response to the "Letter to the Editor" by Gabor Mezei et al., Comments on Vimercati et al., 2019, "Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (Southern Italy) mesothelioma register" — L. Vimercati, D. Cavone, et al. (2019)
• Comments on Vimercati et al., 2019, "Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register" — G. Mezei, E.T. Chang, et al. (2019)
• Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy — L. Vimercati, D. Cavone, et al. (2019)
• Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks — A. Marinaccio, D. Consonni, et al. (2020)
• Environmental asbestos exposure and mesothelioma cases in Bari, Apulia region, southern Italy: a national interest site for land reclamation — L. Vimercati, D. Cavone, et al. (2018)
• Mesothelioma of tunica vaginalis testis and asbestos exposure — C. Mensi, M. Pellegatta, et al. (2012)

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