Malignant gonadal mesothelioma

Our plain-English summary of Malignant gonadal mesothelioma, by N.P. Gupta, R. Kumar (Current Treatment Options in Oncology, 2002).

The study

• Authors: N.P. Gupta, R. Kumar
• Journal: Current Treatment Options in Oncology
• Published: 2002;3(5):363-7
• Type of article: Review
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma of the gonads is a rare and highly lethal disease. Most of these tumors arise from the tunica vaginalis, which is a continuation of the mesothelium similar to the pleura and the peritoneum. However, intratesticular and ovarian mesotheliomas have also been described. Occasionally, patients with localized disease at the time of detection have been known to survive for more than 10 years; however, the majority will not live beyond 5 years, with median survival being approximately 23 months. The principle reasons for this are difficulty in making a preoperative diagnosis and advanced stage at the time of treatment. Surgery forms the mainstay of management for all stages of the tumor. Adjuvant therapy in the form of chemotherapy, immunotherapy, or radiotherapy has negligible benefit. It is essential to diagnose this rare entity at the early stages to allow complete surgical extirpation. For the management of localized disease, we suggest the following protocol: initial staging of suspected cases with computed tomographic scan of the abdomen and pelvis; radical inguinal orchiectomy or hemiscrotectomy; retroperitoneal lymph node dissection in cases with positive nodes on scan or biopsy; and inguinal node dissection in cases requiring hemiscrotectomy. For advanced or recurrent disease, we suggest local radical resection with chemotherapy, including high-dose cisplatin and doxorubicin for two cycles of 5 days each; add local radiotherapy for uncontrolled locally advanced disease.

In plain English

This article was a treatment review and opinion piece by authors from the Department of Urology, All India Institute of Medical Sciences, New Delhi. It drew on their experience and published reports and presented no new patient data. It covered malignant mesothelioma of the gonads, most often arising from the tunica vaginalis, with fewer than 100 cases reported. Citing other studies, the authors stated that asbestos exposure is considered a causative factor of mesotheliomas of the testis, and that the latent period may be up to 40 years. They wrote that most patients do not live beyond 5 years, with median survival of approximately 23 months, though some with localized disease have survived more than 10 years. They described surgery, chiefly radical inguinal orchiectomy, as the mainstay of treatment, and said adjuvant chemotherapy, immunotherapy or radiotherapy has negligible benefit. For advanced or recurrent disease they suggested local radical resection with high-dose cisplatin and doxorubicin. The authors concluded that early diagnosis is essential to allow complete surgical removal. They noted that there are no large series on which to base precise guidelines.

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: Review and expert opinion on treatment, based on the authors' experience and the existing literature; no new patient data
• Who was studied: No study population. The article addresses malignant gonadal mesothelioma, mostly of the tunica vaginalis, though intratesticular and ovarian cases have also been described. It is a rare disease with fewer than 100 cases reported.
• Exposure: Asbestos exposure, described from the cited literature as considered a causative factor of mesotheliomas of the testis. No fiber types, products or doses are given.
• Main results:
  • The authors stated that most gonadal mesotheliomas arise from the tunica vaginalis, but intratesticular and ovarian mesotheliomas have also been described.
  • The authors stated, from the literature, that the majority of patients will not live beyond 5 years, with median survival approximately 23 months. Occasional patients with localized disease have survived more than 10 years.
  • Citing other reports, the authors stated that the latent period between asbestos exposure and tumor development may be up to 40 years. They also stated that under German law a malignant mesothelioma of the testis is evidence of occupational disease for asbestos workers.
  • Citing a published review, the authors stated that local resection of the tumor or hydrocelectomy is associated with a high recurrence rate compared with high inguinal orchiectomy.
  • The authors recommended cisplatin in high doses (35 mg/m2 daily) and adriamycin (doxorubicin, 25 mg/m2 daily) for 5 days per cycle, with the cycle repeated after a 3-week interval.
  • The authors stated that immunotherapy with interleukin-2 and lymphokine-activated killer cells has not been tried in mesotheliomas of the testis, and that its role there remains unclear.
• The authors' conclusion: The authors concluded that surgery is the mainstay of treatment for all stages, that adjuvant therapy has negligible benefit, and that early diagnosis is essential to allow complete surgical removal. They proposed a protocol of CT staging, radical inguinal orchiectomy or hemiscrotectomy, and lymph node dissection where indicated.
• Limitations the authors state:
  • Because so few cases exist, there are no large series on which to base precise therapeutic guidelines.
  • The necessary extent of lymph node dissection is not defined, because few cases have been treated.
  • There are no well-defined protocols for giving the chemotherapy drugs.

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, Malignant Mesothelioma, Tunica Vaginalis, Mesothelium, Pleura, Peritoneum, Median Survival, Adjuvant Therapy.

Related studies

• Treatment of malignant tumors of the spermatic cord: a study of 10 cases and a review of the literature — P.H. Blitzer, D.E. Dosoretz, et al. (1981)
• Adenomatoid tumors of the male and female genital tract are defined by TRAF7 mutations that drive aberrant NF-kB pathway activation — B. Goode, N.M. Joseph, et al. (2018)
• PAX8 and PAX2 immunostaining facilitates the diagnosis of primary epithelial neoplasms of the male genital tract — G.X. Tong, L. Memeo, et al. (2011)
• Paratesticular mesotheliomas — R.E. McDonald, A.L. Sago, et al. (1983)
• Fibrous mesotheliomas (pseudofibroma) of the scrotal sac: a light and ultrastructural study — B. Benisch, B. Peison, et al. (1981)
• Sonography of intrascrotal adenomatoid tumor — W.C. Leonhardt, G.A. Gooding (1992)

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