Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: analysis of published case-series data

Our plain-English summary of Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: analysis of published case-series data, by J.B. Grogg, J.N. Fronzaroli, P. Oliveira, et al (Journal of Cancer Research and Clinical Oncology, 2021).

The study

• Authors: J.B. Grogg, J.N. Fronzaroli, P. Oliveira, P.K. Bode, A. Lorch, A. Issa, J. Beyer, D. Eberli, V. Sangar, T. Hermanns, N.W. Clarke, C.D. Fankhauser
• Journal: Journal of Cancer Research and Clinical Oncology
• Published: 2021;147(9):2671-2679
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: Mesothelioma of the tunica vaginalis testis (MTVT) is a rare tumor, and currently, there are no published treatment recommendations.

Methods: We performed a systematic literature review and synthesized clinical presentation, clinicopathological factors associated with metastatic disease, treatment options, and outcomes in men with MTVT.

Results: We included 170 publications providing data on 275 patients. Metastatic disease occurred in 84/275 (31%) men with malignant MTVT: Most common sites included retroperitoneal lymph nodes (LNs) (40/84, 48%), lungs (30/84, 36%), and inguinal LNs (23/84, 27%). Invasion of the spermatic cord or scrotum was the only risk factor for local recurrence [odds ratio (OR) 3.21, 95% confidence interval (CI) 1.36-7.57]. Metastatic disease was associated with age ≥ 42 years (OR 3.02, 95% CI 1.33-6.86), tumor size ≥ 49 mm (OR 6.17, 95% CI 1.84-20.74), presence of necrosis (OR 8.31, 95% CI 1.58-43.62), high mitotic index (OR 13.36, 95% CI 1.53-116.51) or angiolymphatic invasion (OR 3.75, 95% CI 1.02-13.80), and local recurrence (OR 4.35, 95% CI 2.00-9.44). Complete remission in the metastatic setting was observed in five patients, most of whom were treated with multimodal therapy. Median survival in patients with metastatic disease was 18 months (IQR 7-43).

Conclusion: Malignant MTVT is a rare but aggressive disease. Since local recurrence is a risk factor for metastatic progression, we recommend aggressive local treatment. Survival and response to any treatment in the metastatic setting are limited.

© 2021. The Author(s).

In plain English

This was a systematic review of published reports on mesothelioma of the tunica vaginalis testis (MTVT), a rare tumor of the lining around the testis. The authors pooled 170 publications, made up of 140 single-case reports and 30 case series, describing 275 patients. Of 154 patients whose reports gave information on possible environmental risk factors, 59 (38%) described asbestos exposure. The review did not test asbestos as a risk factor. Local recurrence occurred in 35 of 275 patients (13%). Invasion of the spermatic cord or scrotum was the only factor associated with it (odds ratio 3.21, 95% CI 1.36 to 7.57). Metastatic disease was seen in 84 of 275 patients (31%). In one-factor-at-a-time analyses, metastasis was associated with age 42 or older, tumor size 49 mm or more, necrosis, high mitotic index, angiolymphatic invasion and local recurrence. Of the 84 men with metastases, 55 died during a median follow-up of 18 months, and five had complete remission. The authors concluded that malignant MTVT is rare but aggressive, and they recommended aggressive local treatment. They noted that the evidence came only from retrospective case reports and small series.

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 pooling published case reports and case series (PRISMA method, protocol registered on PROSPERO)
• Who was studied: 275 men with mesothelioma of the tunica vaginalis testis, described in 170 publications (140 single-case reports and 30 case series) published up to 14 January 2019. Of the 275 cases, 227 were classified as malignant mesothelioma.
• Exposure: Asbestos exposure was recorded only as reported in the source publications. Of 154 patients with information on environmental risk factors, 59 (38%) described asbestos exposure. No fiber types, jobs or doses were given. Asbestos was not analysed as a risk factor for recurrence or metastasis.
• Main results:
  • Metastatic disease occurred in 84 of 275 patients (31%). The most common sites were retroperitoneal lymph nodes (40/84, 48%), lungs (30/84, 36%) and inguinal lymph nodes (23/84, 27%).
  • Local recurrence occurred in 35 of 275 patients (13%).
  • In univariable analysis, invasion of the spermatic cord or scrotum was the only factor associated with local recurrence (OR 3.21, 95% CI 1.36 to 7.57, p = 0.008).
  • Using individual patient-level data, metastasis was associated with age 42 years or older (OR 3.02, 95% CI 1.33 to 6.86) and with tumor size 49 mm or more (OR 6.17, 95% CI 1.84 to 20.74).
  • Metastasis was also associated with necrosis (OR 8.31, 95% CI 1.58 to 43.62), high mitotic index (OR 13.36, 95% CI 1.53 to 116.51) and angiolymphatic invasion (OR 3.75, 95% CI 1.02 to 13.80).
  • Metastasis was associated with having had a local recurrence (OR 4.35, 95% CI 2.00 to 9.44).
  • Among the 84 men with metastatic disease, 55 (65%) died and 13 (15%) were alive with disease during a median follow-up of 18 months (IQR 7 to 43). Complete remission was reported in five men.
• The authors' conclusion: The authors concluded that malignant MTVT is a rare but aggressive disease. Because local recurrence is a risk factor for metastatic progression, they recommended aggressive local treatment. They also concluded that survival and response to treatment in men with metastatic disease are limited.
• Limitations the authors state:
  • The published literature consisted only of retrospective case reports and small case series, with few outcome events and missing single-patient data, so multivariable analysis was not possible.
  • The search may not have identified all relevant studies, which is a possible source of bias.

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: Mesothelioma, Tunica Vaginalis, Systematic Review, Spermatic Cord, Odds Ratio, confidence interval, Necrosis, Mitotic Index.

Related studies

• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)
• Imaging of mesothelioma of tunica vaginalis testis — M. Bertolotto, I. Boulay-Coletta, et al. (2016)
• Clinical Features and Outcomes of Tunica Vaginalis Mesothelioma: A Case Series From the National Institutes of Health — J.Y. An, D. Kim, et al. (2017)
• Malignant mesothelioma of the tunica vaginalis testis — K. Antman, S. Cohen, et al. (1984)
• Malignant mesothelioma of tunica vaginalis testis: Report of a very rare case with review of the literature — E. Trenti, S.M. Palermo, et al. (2018)
• Mesothelioma of the tunica vaginalis testis — K.J. Butnor, E.N. Pavlisko, et al. (2019)

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