Malignant mesothelioma of the tunica vaginalis. A clinicopathologic analysis of 11 cases with review of the literature

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis. A clinicopathologic analysis of 11 cases with review of the literature, by M.A. Jones, R.H. Young, R.E. Scully (The American Journal of Surgical Pathology, 1995).

The study

• Authors: M.A. Jones, R.H. Young, R.E. Scully
• Journal: The American Journal of Surgical Pathology
• Published: 1995;19(7):815-25
• Type of article: Review
• Cited by: 124 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Eleven malignant mesotheliomas of the testicular tunica vaginalis occurred in patients aged 12 to 76 (mean, 54.1) years. Hydrocele, with or without an associated mass, or appreciation of a paratesticular mass accounted for the clinical presentation. One patient had a history of asbestos exposure. Grossly, the tumors typically presented as multiple nodules studding a hydrocele sac, frequently associated with a mass infiltrating the spermatic cord or adjacent testis. Microscopically, five tumors were epithelial and six biphasic, with the typical architectural and cytologic features of mesothelioma. Mixtures of papillary, tubular, and solid patterns predominated in the epithelial areas; interlacing fascicles of spindle cells with scanty stroma characterized the sarcomatous components. All eight of the tumors that were stained for keratin (AE1/AE3) were positive, four of five for epithelial membrane antigen, and four of five for vimentin. Seven of seven tumors were carcinoembryonic antigen negative and five of five B72.3, Leu-M1, and Ber-Ep4 negative. Follow-up ranging from 1 to 15 (mean, 4.3) years was available for seven patients. Three died of disease after 4, 4, and 3 years, and three are alive with disease 2, 2, and 15 years after diagnosis. Two of the latter three patients had extensive local recurrences, one 15 years after the diagnosis of a well-differentiated papillary mesothelioma, the other 2 years following treatment with hydrocelectomy only. One patient who has been followed for only 1 year has no evidence of disease. This series emphasizes a number of important features of testicular mesothelioma; (a) a wide age range with occasional occurrence at a young age, (b) a wide morphologic spectrum with regard to degree of differentiation, and (c) an aggressive natural history with a potential for late recurrence or metastasis of even well-differentiated tumors, suggesting the need for initial aggressive surgical treatment.

In plain English

This article was a case series with a review of earlier published reports. The authors, from Maine Medical Center and Massachusetts General Hospital, described 11 patients with malignant mesothelioma of the tunica vaginalis, the lining around the testis. Patients were aged 12 to 76 (mean 54.1) years. Seven patients presented with a hydrocele (fluid around the testis), and the rest had a mass next to the testis. Asbestos information was available for five patients: one had more than 10 years of exposure as a pipefitter, and the other four had no history of exposure. Five tumors were epithelial and six were biphasic. Follow-up was available for seven patients and ranged from 1 to 15 years. Three died of the disease, three were alive with disease, and one had no evidence of disease after one year. Across the 64 cases the authors counted (published cases plus this series), asbestos exposure had been addressed in 27, and 11 of those (41%) had an occupational exposure history. The authors concluded that these tumors behave aggressively, can recur late even when well differentiated, and suggested initial aggressive surgery.

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 series (clinicopathologic analysis) with a review of the published literature
• Who was studied: 11 patients with malignant mesothelioma of the testicular tunica vaginalis, aged 12 to 76 (mean 54.1) years. Cases came from the consultation files of two of the authors (eight), the Maine Medical Center (one), Massachusetts General Hospital (one) and the consultation files of Dr. Austin L. Vickery, Jr. (one). Dates are not given.
• Exposure: Asbestos exposure history (fiber type not stated). Information was available for five of the 11 cases: one patient had more than 10 years of exposure as a pipefitter, and four had no history of exposure.
• Main results:
  • Seven of the 11 patients (64%) presented with a hydrocele. The remaining four had paratesticular masses without a hydrocele.
  • Of the five patients with asbestos information, one had a greater than 10-year history of exposure as a pipefitter. The other four had no history of exposure.
  • Five tumors were epithelial and six were biphasic.
  • All eight tumors stained for cytokeratin (AE1/AE3) were positive. Four of five were positive for EMA and four of five for vimentin. Seven of seven were negative for CEA, and five of five were negative for B72.3, Leu M1 and Ber-Ep4.
  • Follow-up of 1 to 15 (mean 4.3) years was available for seven patients. Three died of disease after 4, 4 and 3 years. Three were alive with disease 2, 2 and 15 years after diagnosis. One patient had no evidence of disease after 1 year.
  • In one patient, a well-differentiated epithelial papillary mesothelioma recurred after 15 years. The recurrent tumor was biphasic and less differentiated.
  • Literature review: asbestos exposure was specifically addressed in only 27 of the 64 reported cases. Of these 27, 11 (41%) were associated with an occupational history of exposure.
  • Literature review: of 13 patients whose tumor was confined to a hydrocele sac and who had at least 2 years of follow-up, six (46%) were without evidence of disease. Of 19 patients with local invasion, distant metastasis or both, only one (5.3%) was without evidence of disease.
• The authors' conclusion: The authors concluded that the series emphasizes three features: a wide age range including young patients, a wide range of differentiation, and an aggressive natural history with potential for late recurrence or metastasis even of well-differentiated tumors. They wrote that this suggests the need for initial aggressive surgical treatment.
• Limitations the authors state:
  • None of the tumors in the series had electron microscopic examination.
  • Analysis of survival according to the different treatments was limited.
  • Long-term follow-up is needed to document fully the natural history of these tumors, because late recurrence is not rare.

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, Hydrocele, Paratesticular, Asbestos Exposure, Spermatic Cord, Biphasic Mesothelioma, Mesothelioma.

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• Malignant Mesothelioma of the Tunica Vaginalis Testis-A Malignancy Associated With Asbestos Exposure and Trauma: A Case Report and Literature Review — A.A. Baqui, N.A. Boire, et al. (2019)
• Case Report of a Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis in an Undescended Testis With Review of Literature — P. Parcesepe, S. Sina, et al. (2016)
• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)
• Malignant mesothelioma of the tunica vaginalis testis: a case report and literature review — J.L. Chen, Y.H. Hsu (2009)

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