Clinical Features and Outcomes of Tunica Vaginalis Mesothelioma: A Case Series From the National Institutes of Health

Our plain-English summary of Clinical Features and Outcomes of Tunica Vaginalis Mesothelioma: A Case Series From the National Institutes of Health, by J.Y. An, D. Kim, S. Tanakchi, et al (Clinical Genitourinary Cancer, 2017).

The study

• Authors: J.Y. An, D. Kim, S. Tanakchi, A.M. Semerjian, A. Thomas, S.L. Boyle, R. Hassan, A.R. Metwalli
• Journal: Clinical Genitourinary Cancer
• Published: 2017;15(5):e871-e875
• Type of article: Case report
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: To present our single-institution experience with management of seven patients with mesothelioma of the tunica vaginalis.

Materials And Methods: Our institution database was queried from 2003 to 2014. Clinical, surgical and pathological features were retrospectively collected and evaluated.

Results: Seven patients were identified with tunica vaginalis mesothelioma. Average age at the time of diagnosis was 63.6 years. Four patients presented with hydrocele, one with scrotal mass, one with inguinal mass, and one with spermatocele. Two (28.6%) patients reported possible asbestos exposure. Radical orchiectomy was performed in all patients. Two patients received adjuvant radiotherapy, one patient received both chemotherapy and radiation. All patients were followed up postoperatively with serial imaging detect for recurrence. One of 7 patients in our cohort experienced recurrence at 12 months. Our mean follow-up time on these patients is 52.2 months.

Conclusion: Previous reported cases have described poor prognosis of tunica vaginalis mesothelioma despite aggressive surgery and systemic therapy. Our single-institution experience suggests relatively good outcomes with surgery and limited adjuvant therapies. Post treatment surveillance is also imperative and should include imaging routinely within the first 2 years. Negative asbestos exposure screening during history should not eliminate clinical suspicion.

In plain English

This case series reviewed National Institutes of Health (NIH) patient records from 2003 to 2014. The authors found 7 patients with tissue-confirmed malignant mesothelioma of the tunica vaginalis, the membrane covering the testicle. Their mean age at diagnosis was 63.6 years (range 43 to 85). Four first came in with a hydrocele, one with a solid scrotal mass, one with a groin mass that looked like a hernia, and one with a spermatocele. Two of the 7 reported possible asbestos exposure, which could not be confirmed. The others had no asbestos exposure by history. All 7 had radical orchiectomy. Two also had radiation, and one had chemotherapy (pemetrexed and cisplatin) plus radiation. One patient had a recurrence 12 months after surgery and died of the disease 5 years after diagnosis. Another was lost to follow-up. Average follow-up for the rest was 52.2 months. The authors saw no clear benefit from adjuvant therapy. They concluded that a lack of asbestos history should not rule out this diagnosis. They also concluded that their lower recurrence rate, compared with earlier reports, might support aggressive surgery and surveillance for localized cases.

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: retrospective case series (review of institutional patient records)
• Who was studied: 7 patients with histology-confirmed malignant mesothelioma of the tunica vaginalis identified in NIH records between 2003 and 2014; mean age at diagnosis 63.6 years (range 43-85)
• Exposure: History of asbestos exposure and smoking, taken from patient history; no fiber types or doses given. 2 of 7 patients reported possible asbestos exposure; 2 other patients were smokers
• Main results:
  • Presentation among the 7 patients: 4 (57.1%) hydroceles, 1 (14.3%) solid scrotal mass, 1 (14.3%) inguinal mass mimicking an inguinal hernia, 1 (14.3%) spermatocele
  • The 2 reported asbestos exposures could not be confirmed; the other 5 patients had no asbestos exposure on the basis of history
  • All 7 patients had radical orchiectomy; 2 received adjuvant radiotherapy and 1 received chemotherapy (pemetrexed and cisplatin) plus radiation
  • One patient had a recurrence 12 months after surgery and died of the disease 5 years after diagnosis
  • One patient was lost to follow-up; average follow-up for the other 6 was 52.2 months (range 15-155 months)
  • The series did not show a clear benefit from adjuvant therapy or a need for lymph node dissection
• The authors' conclusion: The authors concluded that their patients had higher disease-free survival and lower recurrence than reported in the literature, which might support aggressive surgery and surveillance for localized cases. They also concluded that absence of an asbestos history should not rule out the diagnosis.
• Limitations the authors state:
  • The possible asbestos exposures reported by 2 patients could not be confirmed
  • Because the disease is so rare, robust studies of adjuvant therapy are unlikely ever to be completed

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: Testicular Mesothelioma, Mesothelioma, Tunica Vaginalis, Hydrocele, Spermatocele, Asbestos Exposure, Orchiectomy, Chemotherapy.

Related studies

• Mesothelioma of the tunica vaginalis: a series of eight cases with uncertain malignant potential — F. Brimo, P.B. Illei, et al. (2010)
• Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: analysis of published case-series data — J.B. Grogg, J.N. Fronzaroli, et al. (2021)
• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)
• Mesothelioma of the tunica vaginalis testis — K.J. Butnor, E.N. Pavlisko, et al. (2019)
• Mesothelioma of the tunica vaginalis testis: report of 2 cases with asbestos occupational exposure — G. Gorini, M. Pinelli, et al. (2005)
• Mesothelioma of the tunica vaginalis with BerEp4 and LeuM1 expression: identification of cytoplasmic tonofilaments by electron microscopy is a key diagnostic feature — D. Shelton, N. Dalal (2012)

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