Malignant mesothelioma of the tunica vaginalis

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis, by P.E. Spiess, T. Tuziak, W. Kassouf, et al (Urology, 2005).

The study

• Authors: P.E. Spiess, T. Tuziak, W. Kassouf, H.B. Grossman, B. Czerniak
• Journal: Urology
• Published: 2005;66(2):397-401
• Cited by: 22 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objectives: To review our experience with the management of malignant mesothelioma of the tunica vaginalis with emphasis on disease-related outcomes.

Methods: A retrospective chart review of patients seen during the past 25 years at our cancer center identified 5 cases of malignant mesothelioma of the tunica vaginalis.

Results: The mean age of patients at presentation was 61.2 years (range 57 to 83). Asbestos exposure was identified in 4 patients. Three patients presented with clinical symptoms suggestive of a hydrocele and two presented with clinical signs of an inguinal hernia. The final diagnosis was established intraoperatively in 1 patient and postoperatively in the remaining 4. Radical orchiectomy or hernia sac with spermatic cord excision was the primary treatment modality. Although radical surgical treatment achieved negative resection margins in 4 cases, 4 of 5 patients died of the disease, with a mean disease-specific survival of only 29 months (range 5 to 68). Regional inguinal lymph node metastasis developed in 3 of 5 patients. Salvage therapy did not prove curative in the 2 patients who received it.

Conclusions: Malignant mesothelioma of the tunica vaginalis constitutes a rare but often fatal malignancy of the male genitalia. This diagnosis should be suspected in patients exposed to asbestos and presenting with clinical symptoms of either hydrocele or inguinal hernia. Frequent inguinal lymph node involvement indicates a potential role of inguinal lymphadenectomy in the primary treatment.

In plain English

This article was a case series. The authors reviewed the records of five patients treated for malignant mesothelioma of the tunica vaginalis, the lining around the testis, at the M.D. Anderson Cancer Center in Houston between January 1985 and August 2004. Four of the five had been exposed to asbestos through employment or environmental factors. The article does not name fiber types or describe the exposures further. Three patients first appeared to have a hydrocele and two an inguinal hernia. In none was the cancer diagnosed before surgery. All five had surgery, most often radical orchiectomy. Three developed cancer in the regional lymph nodes and four developed distant spread. Four of the five died of malignant mesothelioma, with a mean disease-specific survival of 29 months. One patient remained free of disease at 68 months. Two received salvage chemotherapy without a survival benefit. The authors concluded that this rare but often fatal cancer should be considered when a patient has a scrotal or inguinal mass, particularly if the patient has been exposed to asbestos.

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 case series (chart review) of patients treated at one cancer center
• Who was studied: 5 patients with malignant mesothelioma of the tunica vaginalis seen at the M.D. Anderson Cancer Center, Houston, Texas, between January 1, 1985 and August 15, 2004. Mean age reported as 61.2 years (range 57 to 83); see text problems.
• Exposure: Asbestos exposure through employment or environmental factors in 4 of the 5 patients. No fiber types, products, jobs or doses are given.
• Main results:
  • Of the 5 patients, 3 presented with signs suggesting a hydrocele and 2 with signs consistent with an inguinal hernia.
  • The cancer was not diagnosed before surgery in any patient. It was diagnosed after surgery in 4 patients and during surgery (frozen section) in 1.
  • Regional lymph node metastases developed in 3 of the 5 patients (60%), and distant metastases in 4 (80%).
  • Mean survival after distant metastases developed was 6 months (range 4 to 9) among the 4 patients with distant metastases.
  • 4 of the 5 patients died of malignant mesothelioma, with a mean disease-specific survival of 29 months.
  • 1 patient remained free of disease, with a disease-free survival of 68 months.
  • Salvage chemotherapy given to 2 patients did not produce a survival benefit.
  • In these patients, pathologic stage did not correlate with the rate of metastasis or with survival.
• The authors' conclusion: The authors concluded that malignant mesothelioma of the tunica vaginalis is a rare but often fatal cancer. They said it should be considered when a patient has a scrotal or inguinal mass, particularly if the patient has been exposed to asbestos.
• Limitations the authors state:
  • The authors classed peritoneal mesothelioma in one patient as metastatic spread, but noted it could instead be a separate site of the original disease.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Tunica Vaginalis, Asbestos Exposure, Hydrocele, Inguinal Hernia, Orchiectomy, Spermatic Cord, Metastasis.

Related studies

• Imaging of mesothelioma of tunica vaginalis testis — M. Bertolotto, I. Boulay-Coletta, et al. (2016)
• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)
• 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)
• Mesothelioma of the tunica vaginalis testis — K.J. Butnor, E.N. Pavlisko, et al. (2019)
• 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)
• Mesothelioma of tunica vaginalis testis and asbestos exposure — C. Mensi, M. Pellegatta, et al. (2012)

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