Concomitant malignant mesothelioma of the pleura, peritoneum, and tunica vaginalis testis

Our plain-English summary of Concomitant malignant mesothelioma of the pleura, peritoneum, and tunica vaginalis testis, by V. Ascoli, F. Facciolo, S. Rahimi, et al (Diagnostic Cytopathology, 1996).

The study

• Authors: V. Ascoli, F. Facciolo, S. Rahimi, C.C. Scalzo, F. Nardi
• Journal: Diagnostic Cytopathology
• Published: 1996;14(3):243-8
• Type of article: Case report
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We describe the cytohistological, immunohistochemical and ultrastructural findings in a 55-yr-old-man with history of asbestos exposure and diffuse malignant mesothelioma (DMM) of the pleura, peritoneum, and tunica vaginalis presenting with chest pain and scrotal swelling. Pleural fine-needle aspiration (FNA) revealed mesenchymal elements and spindle-shaped epithelial-like cells, while biopsy showed pure sarcomatous tumor invading lung parenchymal. In both samples tumor cells coexpressed cytokeratin and vimentin. Peritoneal and hydrocele effusions contained aggregates of malignant mesothelial cells. Electron microscopy showed intermediate filaments, rare desmosomes and sparse microvilli. Morphological findings were consistent with a DMM, with a biphasic pattern in the pleura and an epithelial one in the peritoneum and tunica vaginalis. Although the possibility of a multicentric origin cannot be ruled out, clinical chronologic sequence suggests that the pleura was the primary involved site, followed by spread to peritoneum and tunica vaginalis.

In plain English

This was a case report about one man. He was 55 years old, smoked, and had a long history of work exposure to asbestos as supervisor of the heating power station in a tire manufacturing plant, where he was in contact with thermal insulation materials. He was diagnosed with diffuse malignant mesothelioma affecting three linings at once: the pleura (around the lungs), the peritoneum (abdomen) and the tunica vaginalis (around the testis). The diagnosis rested on small needle and fluid samples, with special stains and electron microscopy. The pleural tumor was classed as biphasic and the other two as epithelial. No asbestos bodies were seen in a bronchial washing. He died at home 6 months after admission, and no autopsy was done. The authors concluded that the order of events suggested the pleura was involved first, with later spread to the other sites. They said that without extensive sampling or an autopsy they could not tell for certain whether the other tumors were spread from the pleura or separate tumors. They suggested that his exposure to asbestos insulation might have caused the tumors.

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: case report
• Who was studied: One 55-year-old male smoker referred to a hospital in Rome, Italy, for chest pain and sudden scrotal swelling, with a 1-year history of recurrent pleural effusion
• Exposure: Long-term occupational asbestos exposure through contact with thermal insulation materials as supervisor of the heating power station in a tire manufacturing plant. No fiber type is named.
• Main results:
  • In the pleural fine-needle aspirate, tumor cells of both components (spindle-shaped mesenchymal cells and epithelial-like cells) were strongly positive for cytokeratin and vimentin.
  • The pleural core biopsy showed spindle-shaped tumor cells growing into the lung, and these cells expressed both cytokeratin and vimentin.
  • In the peritoneal fluid and the hydrocele (scrotal) fluid samples, all tumor cells were positive for cytokeratin.
  • The disease was diagnosed as diffuse malignant mesothelioma, Stage IV. The pleural tumor was classed as biphasic, and the peritoneal and tunica vaginalis tumors as epithelial.
  • The bronchial washing showed no asbestos bodies.
  • The patient died at home 6 months after hospital admission, and no autopsy was performed.
  • The authors suggested that direct exposure to asbestos used as thermal insulation might have led to the mesotheliomas. They also noted that the tire industry widely uses talc powders that can be contaminated with asbestos.
• The authors' conclusion: The authors concluded that the order of clinical events suggests the pleura was the first site involved, followed by the peritoneum and then extension to the tunica vaginalis. They said separate, independent tumors could not be ruled out.
• Limitations the authors state:
  • Neither extensive tumor sampling nor an autopsy was performed, so the authors could not determine with certainty whether the peritoneal and tunica vaginalis tumors were spread from the pleural tumor or independent tumors.

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleura, Peritoneum, Tunica Vaginalis, Asbestos Exposure, Fine-Needle Aspiration, Biopsy, Hydrocele.

Related studies

• A case of mesothelioma of the tunica vaginalis testis, with involvement of the pleura and peritoneum — A. Poggi, F. Longo, et al. (2000)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Nodular hemangiomatosis of pleura and peritoneum — S. Ribback, A. Thiele, et al. (2011)
• Malignant mesothelioma of tunica vaginalis testis — K.T. Chen, R.B. Arhelger, et al. (1982)
• Mesothelioma of the tunica vaginalis testis: report of 2 cases with asbestos occupational exposure — G. Gorini, M. Pinelli, et al. (2005)
• Malignant Mesothelioma of the Tunica Vaginalis Testis-A Malignancy Associated With Asbestos Exposure and Trauma: A Case Report and Literature Review — A.A. Baqui, N.A. Boire, et al. (2019)

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