Cutaneous Metastases From Malignant Mesothelioma of the Tunica Vaginalis Testis

Our plain-English summary of Cutaneous Metastases From Malignant Mesothelioma of the Tunica Vaginalis Testis, by P. Hispán, J.C. Pascual, I. González, et al (The American Journal of Dermatopathology, 2016).

The study

• Authors: P. Hispán, J.C. Pascual, I. González, D. Bravo, G. Peiró
• Journal: The American Journal of Dermatopathology
• Published: 2016;38(3):222-5
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesotheliomas are uncommon tumors arising from mesothelial cells lining the serous membranes of the pleura, pericardium, peritoneum, and tunica vaginalis testis. Less than 100 cases arising from the tunica vaginalis testis have been published and, to our knowledge, only 5 cases of cutaneous involvement from these tumors have been reported. We report an additional case with fatal outcome. A 93-year-old man presented with multiple polypoid nodules on the left scrotum. Ulceration was also present, and a firm 5-cm palpable testicular mass was also found. The patient had been exposed to asbestos for 40 years. Histologic examination of a skin biopsy from one of the nodules showed diffuse dermal infiltration of markedly atypical cuboidal cells, with polymorphous and hyperchromatic nuclei. Mitotic figures were common. These cuboidal cells lined clefts, forming a tubular and micropapillary pattern throughout papillary and reticular dermis. Immunohistochemical study showed strong nuclear and cytoplasmic positivity for calretinin, epithelial membrane antigen (cytoplasmic), and cytokeratin-7 (cytoplasmic) and nuclear positivity for Wilms tumor-1. These findings were consistent with cutaneous infiltration from malignant mesothelioma of the tunica vaginalis testis. Treatment of this rare tumor remains challenging because there are currently no recommended guidelines, but radical inguinal orchiectomy is an optimal choice.

In plain English

This article is a case report about one patient seen at a university hospital in Alicante, Spain. A 93-year-old man came in with several painful, skin-colored nodules, 1 to 2 cm across, on the left side of the scrotum. Some were ulcerated, and there was also a firm 5-cm testicular mass. The patient had been exposed to asbestos for 40 years as a worker in an aluminum factory. The article does not name the fiber type. A skin biopsy showed markedly atypical cells spreading through the skin. Staining tests were positive for calretinin, epithelial membrane antigen, cytokeratin-7 and Wilms tumor-1. These findings were consistent with malignant mesothelioma of the tunica vaginalis testis (a lining around the testicle) spreading to the skin. Scans showed a 5.5-cm testicular mass, enlarged lymph nodes in the groin and abdomen, lung metastases, and findings from asbestos exposure. Because of the patient's age and limited condition, only palliative treatment was offered. The authors described the outcome as fatal. They concluded that treatment of this tumor remains challenging because there are no recommended guidelines, but that radical inguinal orchiectomy is an optimal choice.

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 (single patient)
• Who was studied: One 93-year-old man with nodules on the left scrotum, seen at the Departments of Dermatology, Urology and Pathology, University General Hospital of Alicante, Spain; no date of presentation given
• Exposure: Asbestos exposure for 40 years as a worker in an aluminum factory; fiber type not stated
• Main results:
  • The patient had surgery for a left hydrocele 3 months before this visit
  • A skin biopsy of one nodule showed markedly atypical cuboidal cells spreading through the dermis, and lymphovascular invasion was detected
  • Immunohistochemistry was strongly positive for calretinin, epithelial membrane antigen and cytokeratin-7, with nuclear positivity for Wilms tumor-1. This was consistent with skin infiltration from malignant mesothelioma of the tunica vaginalis testis
  • Testicular ultrasound showed a heterogeneous 5.5-cm mass on the left testicle
  • Total body CT showed left inguinal lymph node enlargement (largest about 25 mm) and enlarged lymph nodes near the aorta
  • Lung metastases and findings from asbestos exposure were confirmed
  • Because of the patient's age and limited baseline status, only palliative treatment was offered. The authors describe the outcome as fatal
• The authors' conclusion: The authors concluded that treatment of this rare tumor remains challenging because there are no recommended guidelines, but that radical inguinal orchiectomy is an optimal choice. This patient received only palliative treatment.

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, Mesothelial Cells, Pleura, Pericardium, Peritoneum, Biopsy, Micropapillary.

Related studies

• Cutaneous manifestations of malignant mesothelioma of the tunica vaginalis testis — H.J. van der Rhee, W.A. van Vloten, et al. (1983)
• Malignant papillary mesothelioma of the tunica vaginalis testes: cutaneous metastases showing pagetoid epidermal invasion — L.E. Cartwright, H.K. Steinman (1987)
• Cutaneous recurrence of malignant mesothelioma of the tunica vaginalis testis: a rare case report — P. Priester, J. Kopecký, et al. (2012)
• Mesothelioma of the tunica vaginalis testis: report of 2 cases with asbestos occupational exposure — G. Gorini, M. Pinelli, et al. (2005)
• Case Report of a Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis in an Undescended Testis With Review of Literature — P. Parcesepe, S. Sina, et al. (2016)
• A new case of malignant mesothelioma of the tunica vaginalis testis. Immunohistochemistry in comparison with an adenomatoid tumor of the testis — H. Moch, H. Ohnacker, et al. (1994)

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