Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature, by M. Drevinskaite, A. Patasius, L. Kevlicius, et al (BMC Cancer, 2020).

The study

• Authors: M. Drevinskaite, A. Patasius, L. Kevlicius, U. Mickys, G. Smailyte
• Journal: BMC Cancer
• Published: 2020;20(1):162
• Type of article: Case report, Review
• Cited by: 34 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant mesothelioma of the tunica vaginalis is a rare tumour which comprises less than 1% of all mesotheliomas.

Case Presentation: 69-years old patient with painful hard mass and hydrocele in the right scrotum to whom a right hydrocelectomy was performed. Any history of scrotal trauma or exposure to asbestos was not present. Excisional biopsy revealed a multinodular tumour with focal areas of necrosis and infiltrative growth. According to morphological and immunohistochemical findings, diagnosis of malignant biphasic mesothelioma of the tunica vaginalis testis was made. Two months after hydrocelectomy, right inguinal orchidectomy was performed. Post-surgical whole body CT scan revealed paraaortic and pararenal lymphadenopathy, likely to be metastatic. Adjuvant treatment with 6 cycles of cisplatin and pemetrexed was applied. After 3 cycles of chemotherapy, CT scan showed progression and the treatment was changed to gemcitabine 1 month after.

Conclusions: Although malignant mesothelioma of the tunica vaginalis is a rare malignancy, it poses a diagnostic challenge which can mimic common inguinal or scrotal diseases such as hydrocele. Despite aggressive surgical procedures or adjuvant therapies, the prognosis remains poor.

In plain English

This article is a case report from Lithuania, with a discussion of published literature, about one patient with malignant mesothelioma of the tunica vaginalis testis, the lining around the testicle. A 69-year-old man had a painful, hard mass and a fluid collection (hydrocele) in the right scrotum. Suspicious tissue was found during surgery to remove the hydrocele. The patient denied any history of asbestos exposure. He had received external beam radiotherapy for prostate cancer 8 years earlier. Tissue examination led to a diagnosis of malignant biphasic mesothelioma. The authors noted that the biopsy lacked common features of mesothelioma. Two months later the right testicle was removed, and a CT scan showed enlarged lymph nodes that were likely to be metastatic. After 3 cycles of cisplatin and pemetrexed chemotherapy, the disease progressed and treatment was changed to gemcitabine. The patient died 9 months after diagnosis. The authors concluded that this rare tumour can mimic common conditions such as hydrocele and that the prognosis remains poor despite aggressive treatment.

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 with a review of the literature
• Who was studied: One 69-year-old man referred to a hospital in Lithuania (authors based in Vilnius) after right hydrocelectomy, during which suspicious tissue was found; he had an edematous right scrotum with a hard, painful mass. Date of the case not stated.
• Exposure: No known history of asbestos exposure (the patient denied it). He had received external beam radiotherapy (74 Grays in 37 fractions) for prostate adenocarcinoma 8 years earlier.
• Main results:
  • Based on morphological and immunohistochemical findings, the tumour was diagnosed as malignant biphasic mesothelioma of the tunica vaginalis testis.
  • According to the authors, the pre-operative biopsy specimen lacked common features of mesothelioma.
  • Two months after the hydrocelectomy, the right testicle was removed (right inguinal orchidectomy).
  • A whole-body CT scan after surgery showed paraaortic and pararenal lymph node enlargement, likely to be metastatic.
  • After 3 cycles of cisplatin and pemetrexed, a CT scan showed progression, and treatment was changed to gemcitabine 1 month later.
  • The patient died 9 months after diagnosis.
• The authors' conclusion: The authors concluded that malignant mesothelioma of the tunica vaginalis, though rare, is a diagnostic challenge that can mimic common inguinal or scrotal conditions such as hydrocele, and that despite aggressive surgery or adjuvant therapies the prognosis remains poor.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Hydrocele, Hydrocelectomy, Biopsy, Necrosis, Biphasic Mesothelioma, CT Scan.

Related studies

• 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 the tunica vaginalis testis: a rare malignancy mimicking more common inguino-scrotal masses — P.J. Schure, K.C. van Dalen, et al. (2006)
• 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)
• Extremely rare tumour--malignant mesothelioma of tunica vaginalis testis — T. Jankovichova, M. Jankovich, et al. (2015)
• Papillary serous carcinoma of the tunica vaginalis testis — P. Becerra, M.A. Isaac, et al. (2000)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)

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