Imaging of mesothelioma of tunica vaginalis testis

Our plain-English summary of Imaging of mesothelioma of tunica vaginalis testis, by M. Bertolotto, I. Boulay-Coletta, R. Butini, et al (European Radiology, 2016).

The study

• Authors: M. Bertolotto, I. Boulay-Coletta, R. Butini, S.M. Dudea, N. Grenier, G. Oltmanns, P. Ramchandani, M.W. Stein, M. Valentino, L.E. Derchi
• Journal: European Radiology
• Published: 2016;26(3):631-8
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis.

Methods: We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis.

Results: A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection.

Conclusions: A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity.

Key Points: Mesotheliomas of the tunica vaginalis are rare, often challenging to diagnose preoperatively. Most common finding is a complex hydrocele with hypervascular parietal vegetations. Septated hydrocele, nodules without hydrocele, a thick-walled paratesticular cyst are less common. Preoperative diagnosis may allow aggressive surgical approach and, possibly, a better prognosis.

In plain English

This retrospective case series, drawn from ten institutions, described how mesothelioma of the tunica vaginalis testis (the lining around the testis) looked on scans before surgery. The authors reviewed ten pathology-proven cases in men aged 34 to 82. All had scrotal ultrasound and two had MR imaging. The most common appearance, in five patients, was fluid around the testis (a hydrocele) with solid growths on its wall that had a rich blood supply. Three patients had solid masses without a hydrocele. Of seven patients with follow-up information, two died of the disease, after 2 and 11 years, and five were alive without disease 6 to 66 months later. The authors could not obtain information on asbestos exposure. They concluded that the diagnosis must be considered when a hydrocele with growths on its wall is seen, especially if the growths show high blood flow, but that it seems quite difficult when the tumour appears as a solid mass. They named the small number of patients and the retrospective design as the main limitations.

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, observational, multicentre case series describing imaging findings
• Who was studied: 10 pathology-proven cases of mesothelioma of the tunica vaginalis testis from ten institutions, gathered through a call for cases published by the European Society of Urogenital Radiology in spring 2014. Ages ranged from 34 to 82 years. The tumour was on the right side in 5 men, the left in 4 and both sides in 1.
• Exposure: Not studied. The authors were unable to obtain information about asbestos exposure in these patients. The imaging methods reviewed were scrotal ultrasound (all 10, with contrast-enhanced ultrasound in 1) and MR imaging (2).
• Main results:
  • Presenting symptoms were scrotal enlargement in 6 of the 10 patients and a palpable mass in 4.
  • The most common imaging finding, in 5 of 10 patients, was a hydrocele containing echogenic fluid with hypervascular (rich blood supply) solid growths on its wall.
  • One patient had a septated hydrocele with hypervascularity on the surface of the tunica vaginalis. One had a paratesticular cystic mass interpreted as a loculated hydrocele with tumour growths in its walls.
  • Three patients had solid masses that were not associated with a hydrocele.
  • In the 2 patients with MR imaging, all lesions had low signal on T2-weighted images and were hypervascular after contrast injection.
  • Staging data were available for 6 of 10 patients. Four had a negative CT study at diagnosis, one had a positive retroperitoneal lymph node, and one had enlarged retroperitoneal lymph nodes with masses both inside the abdomen and in the scrotum.
  • Follow-up was available for 7 of 10 patients. Two died of the disease, one after 2 years and one 11 years after diagnosis. The other five were alive without disease, with follow-up ranging from 6 to 66 months.
• The authors' conclusion: The authors concluded that this diagnosis must be considered in patients with a hydrocele with growths on its wall, especially if these show high vascularity. They found that a preoperative diagnosis seems very difficult with imaging when the tumour presents as a solid mass next to the testis. They also suggested that aggressive surgery may have contributed to prolonged survival, while stating that the series is too small to draw any firm conclusion.
• Limitations the authors state:
  • The principal limitations were the small number of patients and the retrospective design. Many cases came from anonymously archived teaching files, so full patient information could not be retrieved.
  • No information on asbestos exposure could be obtained.
  • With only three cases (the authors' two plus one published case), no conclusion could be drawn about the MR appearance of these tumours.
  • Pathology reports were available for only 8 of the 10 patients, and pathology images could be reviewed in only 5.
  • Survival observations were limited by the small series; the authors said it was too small to draw firm conclusions.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Pathology, Hydrocele, Paratesticular, Prognosis.

Related studies

• Mesothelioma of the tunica vaginalis testis: a rare malignancy mimicking more common inguino-scrotal masses — P.J. Schure, K.C. van Dalen, et al. (2006)
• Fine needle aspiration cytology in malignant mesothelioma of the tunica vaginalis testis — R. Gupta, P. Dey, et al. (2011)
• 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 tunica vaginalis testis: Report of a very rare case with review of the literature — E. Trenti, S.M. Palermo, et al. (2018)
• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)
• Papillary serous carcinoma of the tunica vaginalis testis — P. Becerra, M.A. Isaac, et al. (2000)

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