Malignant mesothelioma of the tunica vaginalis

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis, by M. Abdelrahman, C. Dowling, K. O'Connor, et al (Journal of Surgical Case Reports, 2012).

The study

• Authors: M. Abdelrahman, C. Dowling, K. O'Connor, N. Mayer, E. Kiely
• Journal: Journal of Surgical Case Reports
• Published: 2012;2012(5):2
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma of the tunica vaginalis is a rare but potentially fatal disease. Lack of characteristic clinical features and tumour markers makes the pre-operative diagnosis very difficult. A 54 year-old man with no history of exposure to asbestos presented with a short history of scrotal swelling and pain. Ultrasound revealed a suspicious nodularity involving his tunica vaginalis, suggestive of mesothelioma. Excisional biopsy revealed a malignant mesothelioma; hence the patient was treated with radical inguinal orchidectomy and hemiscrotectomy. We present a case of this rare tumour, its management and a review of the literature.

© JSCR.

In plain English

This case report from Cork University Hospital, Ireland, described one patient with malignant mesothelioma of the tunica vaginalis, the lining around the testis. The patient, a 54-year-old male farmer and ex-smoker, had two weeks of right testicular pain and swelling. He denied exposure to asbestos in his occupation. Blood tests including HCG, AFP and LDH were normal. Ultrasound showed multiple lesions confined to the tunica vaginalis, judged highly suspicious for mesothelioma. A CT scan showed no evidence of spread. At surgery, small lesions were found on both testes. The largest, on the right, measured 6 mm. The right-side lesion was diagnosed as biphasic malignant mesothelioma, made up of epithelioid and spindled cells. The tiny left-side specimens showed no malignancy. The right testis and half of the scrotum were then removed, and no remaining cancer was found in the removed tissue. The patient was placed under surveillance. The authors described the diagnosis by ultrasound before surgery as unusual for this tumour. Most of the discussion reviewed earlier published studies, and the figures given there came from those studies rather than from this case.

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 54-year-old male farmer, ex-smoker, with two weeks of right testicular pain and swelling, seen at Cork University Hospital, Ireland
• Exposure: The patient denied exposure to asbestos in his occupation. The authors describe the case as having no history of asbestos exposure.
• Main results:
  • In this patient, blood tests including HCG, AFP and LDH were within normal limits
  • Ultrasound showed multifocal echogenic lesions with internal blood flow, confined to the tunica vaginalis. These were considered highly suspicious for mesothelioma.
  • A staging CT scan of the thorax, abdomen and pelvis showed no evidence of metastatic disease
  • At surgery, small lesions were found on both testes: the largest, on the right, measured 6 mm, and the left lesions measured 2 to 3 mm
  • The right-side biopsy showed a biphasic nodule of epithelioid and spindled cells, consistent with malignant mesothelioma. The tiny left-side specimens showed no malignancy.
  • After right inguinal orchidectomy and hemiscrotectomy, no residual malignancy was found in the final specimen
  • The patient was kept under surveillance with clinical and ultrasound follow-up
• The authors' conclusion: The authors concluded that diagnosis by ultrasound before surgery, as in this case, is unusual for this potentially aggressive tumour, which lacks tumour markers and characteristic clinical features

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Tunica Vaginalis, Ultrasound, Mesothelioma, Biopsy, Hemiscrotectomy.

Related studies

• Malignant mesothelioma of the tunica vaginalis. A clinicopathologic analysis of 11 cases with review of the literature — M.A. Jones, R.H. Young, et al. (1995)
• 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)
• Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis — S.S. Chekol, C.C. Sun (2012)
• Mesothelioma of the tunica vaginalis: a series of eight cases with uncertain malignant potential — F. Brimo, P.B. Illei, et al. (2010)

Browse return to medical research.