Malignant Epithelioid Mesothelioma of the Tunica Vaginalis Testis Presenting as Hydrocele in a Kidney Transplant Recipient

Our plain-English summary of Malignant Epithelioid Mesothelioma of the Tunica Vaginalis Testis Presenting as Hydrocele in a Kidney Transplant Recipient, by B.M. Behers, C.W. Guske, B.J. Behers, et al (Case Reports in Urology, 2024).

The study

• Authors: B.M. Behers, C.W. Guske, B.J. Behers, S.B. Kortum, I.G. Bermingham, C.L. Warner, R.I. Carey
• Journal: Case Reports in Urology
• Published: 2024;2024:9227764
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesotheliomas of the tunica vaginalis testis are rare malignant tumors that can present as a scrotal mass or hydrocele. These tumors are typically aggressive with high rates of recurrence and metastasis. Suspected risk factors for malignant mesothelioma include asbestos exposure, chronic inflammation, trauma, and persistent hydrocele. We report the case of a malignant epithelioid mesothelioma of the tunica vaginalis testis that presented as a finding at hydrocelectomy and was ultimately treated with radical inguinal orchiectomy. This patient was on chronic immunosuppression therapy with tacrolimus and mycophenolate mofetil secondary to a kidney transplant but had none of the common risk factors for mesothelioma formation. To our knowledge, this is the first case describing a possible connection between chronic immunosuppression and mesothelioma of the tunica vaginalis. However, future studies are needed to investigate this association and discern whether this could have played a role in our patient or if his mesothelioma formation was coincidental.

Copyright © 2024 Brett M. Behers et al.

In plain English

This case report described one patient. An 80-year-old man had six months of right-sided scrotal swelling. He had received a kidney transplant in 2012 and since then had taken the immunosuppressive drugs tacrolimus and mycophenolate mofetil. Ultrasound showed a large right-sided hydrocele (fluid around the testicle). Draining it three times gave no lasting relief, so it was removed surgically. The lining around the testicle, the tunica vaginalis, was abnormally thick, and pathology found an epithelioid malignant mesothelioma. CT imaging showed no spread. Three weeks later the right testicle was removed (inguinal orchiectomy). Four months later, scans showed no recurrence or spread. He had no chemotherapy or radiation. His records and his own account showed no smoking, testicular trauma, or known asbestos exposure, although the authors said asbestos exposure cannot be ruled out. The authors speculated that his transplant status or immunosuppressive drugs may have been related to the tumor. They also said it may have been coincidental and that more research is needed.

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 (one patient)
• Who was studied: One 80-year-old male patient seen at the authors' urology clinic (Sarasota, Florida, USA), a kidney transplant recipient since 2012, with six months of right-sided scrotal swelling
• Exposure: No known asbestos exposure was found. The patient had long-term immunosuppressive therapy with tacrolimus and mycophenolate mofetil after a kidney transplant, and the authors discussed this as a possible factor.
• Main results:
  • Tissue from the abnormally thickened tunica vaginalis removed at hydrocelectomy was diagnosed as epithelioid malignant mesothelioma
  • CT of the chest, abdomen and pelvis showed no evidence of spread (metastasis) at diagnosis
  • At the right inguinal orchiectomy three weeks later, frozen sections taken during surgery showed clear margins
  • At follow-up four months later, CT and scrotal ultrasound showed no local recurrence and no metastases. The patient received no adjuvant chemotherapy or radiation.
  • The patient had none of the common risk factors for mesothelioma, including no smoking, testicular trauma, or known asbestos exposure
• The authors' conclusion: The authors speculated that, with no other risk factors, the patient's mesothelioma may have been related to his kidney transplant status or immunosuppressive therapy. They stated that additional research is warranted to explore possible relationships between mesothelioma, chronic immunosuppression and kidney transplant status.
• Limitations the authors state:
  • Given past widespread use of asbestos, asbestos exposure cannot be ruled out
  • The patient was not tested for simian virus 40 (SV40), which the authors discussed as a possible cause
  • The mesothelioma may have been coincidental and unrelated to transplant status or immunosuppression

Topics

Medical terms in this study, explained in our Lexicon: Epithelioid, Mesothelioma, Tunica Vaginalis, Hydrocele, Metastasis, Asbestos Exposure, Chronic Inflammation, Hydrocelectomy.

Related studies

• Risk of de novo cancers after transplantation: results from a cohort of 7217 kidney transplant recipients, Italy 1997-2009 — P. Piselli, D. Serraino, et al. (2013)
• Malignant pleural mesothelioma in a kidney transplant recipient — W. Traipipitsiriwat, C. Songsomboon, et al. (2021)
• Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology — S.C. Gupta, A.K. Gupta, et al. (1998)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Malignant mesothelioma of the tunica vaginalis testis — K. Antman, S. Cohen, et al. (1984)
• Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2017)

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