Malignant mesothelioma of the tunica vaginalis testis

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis testis, by K. Antman, S. Cohen, N.V. Dimitrov, et al (Journal of Clinical Oncology, 1984).

The study

• Authors: K. Antman, S. Cohen, N.V. Dimitrov, M. Green, F. Muggia
• Journal: Journal of Clinical Oncology
• Published: 1984;2(5):447-51
• Type of article: Case report
• Cited by: 64 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001675).

Abstract

Eighteen patients with malignant mesothelioma of the tunica vaginalis testis have been previously reported. These and the six patients reported here are reviewed for natural history and response to treatment. This tumor should be considered in men of any age with scrotal masses that include a hydrocele. Staging procedures should include computerized tomography scanning of the chest and abdomen. Inguinal orchiectomy appears to be the optimal primary surgical approach. Intraabdominal disease found at diagnostic laparotomy may be effectively treated by surgery and/or abdominal radiotherapy. Clinical features such as a long asymptomatic interval from initial presentation to clinical recurrence were observed and are also worthy of emphasis. Thus, serial follow-up is advised. Upon recurrence, treatment remains unsatisfactory but some responsiveness to chemotherapy has been noted. Doxorubicin-containing regimens were administered to five patients with measurable pulmonary nodules resulting in two partial regressions by standard criteria.

In plain English

This article reported six new patients with malignant mesothelioma of the tunica vaginalis testis (the lining around the testicle) and reviewed 18 cases published since the condition was first described in 1957. Four of the six new patients were described as heavily exposed to asbestos. The article did not name fiber types. Across all 24 patients, the median age was 61 years (range 21 to 78). Six had a history of asbestos exposure, with 8 to 40 years between first contact and the tumor. A hydrocele (fluid around the testicle) was present in 13 patients. Doxorubicin-containing chemotherapy given to five patients with measurable lung nodules produced two partial regressions. Ten patients remained disease-free for 1.5 months to 15 years. Among 13 who relapsed, median disease-free survival was 20.0 months. The authors considered inguinal orchiectomy the optimal first surgery. They noted that selective case reporting may bias the data. The authors concluded that this tumor should be considered in men of any age with scrotal masses that include a hydrocele.

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 of six new patients combined with a review of previously published case reports
• Who was studied: Six newly reported men (ages 23 to 73) with malignant mesothelioma of the tunica vaginalis testis, plus 18 cases previously reported in the literature since 1957; 24 patients in total, median age 61 years (range 21 to 78)
• Exposure: Occupational asbestos contact (fiber type not specified). Among the new patients: a man with 25 years of intermittent contact in a naval shipyard and as a plumber, a machinist with a 20-year history, and a construction worker with 16 years of contact. One new patient (a postal clerk) reported no asbestos exposure. Prior trauma to the testicle was also recorded.
• Main results:
  • Of all 24 patients, six had a history of asbestos exposure: two of the earlier reported patients and four of the six new patients.
  • The interval from first asbestos contact to mesothelioma ranged from eight to 40 years in the exposed patients.
  • The tumor involved the left side in nine patients and the right in 13. A hydrocele was present at diagnosis in 13 patients.
  • Doxorubicin-containing regimens given to five patients with measurable lung nodules produced two partial regressions by standard criteria.
  • In new patient no. 1, lung metastases and an abdominal mass shrank by 70% during six courses of cyclophosphamide and doxorubicin.
  • Ten patients remained disease-free between 1.5 months and 15 years from diagnosis (median 12 months).
  • Among the 13 patients known to have relapsed, median disease-free survival was 20.0 months (range 1.5 months to 10 years).
  • The authors considered inguinal orchiectomy the optimal first surgery. The two new patients with primary transcrotal resections (patients no. 2 and 4) had multiple local recurrences.
• The authors' conclusion: The authors concluded that this tumor should be considered in men of any age with scrotal masses that include a hydrocele.
• Limitations the authors state:
  • Selective case reporting may bias the available data. Patients with metastases are probably reported more often than those who stay disease-free after orchiectomy.

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, Staging, Orchiectomy, Laparotomy, Chemotherapy, Doxorubicin.

Related studies

• 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)
• Malignant mesothelioma of the tunica vaginalis testis related to recent asbestos — Y. Ikegami, N. Kawai, et al. (2008)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• 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)
• Malignant mesothelioma of tunica vaginalis testis — G. Tyagi, C.S. Munn, et al. (1989)

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