Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis, by L. Japko, A.A. Horta, K. Schreiber, et al (Cancer, 1982).

The study

• Authors: L. Japko, A.A. Horta, K. Schreiber, S. Mitsudo, G.L. Karwa, G. Singh, L.G. Koss
• Journal: Cancer
• Published: 1982;49(1):119-27
• Type of article: Case report
• Cited by: 66 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. 001770).

Abstract

The cytologic, histologic and ultrastructural features of a malignant carcinomatous mesothelioma of the tunica vaginalis testis in a 30-year old patient are described. This is the first such case with preoperative diagnosis by cytologic examination of hydrocele fluid and the second with documented history of exposure to asbestos. The identity of the tumor was confirmed by a positive immunoperoxidase reaction directed against mesothelial cells. A review of the previously described ten cases is presented.

In plain English

This was a case report with a review of earlier published cases. The authors described a 30-year-old man with painless right scrotal swelling. His malignant carcinomatous mesothelioma of the tunica vaginalis testis (the lining around the testicle) was diagnosed before surgery by examining fluid drawn from a hydrocele. Surgery confirmed the diagnosis, and his right testicle was removed. Immunoperoxidase staining and electron microscopy supported a tumor of mesothelial origin. For eight years, ending two years before admission, he had worked as a pipefitter at an oil refinery, placing thick asbestos insulation around pipelines and straddling the pipes. The fiber type was not stated. No asbestos bodies were found in his fluid, and neither asbestos bodies nor fibers were found in 1.3 g of digested tumor tissue. Six months after surgery he was well. Across eleven cases (ten earlier plus this one), occupational history had been sought in five, and two, including this patient, reported asbestos exposure. His first exposure was only ten years earlier, which the authors wrote probably does not negate a causal relationship. The authors concluded that early diagnosis by hydrocele fluid cytology may prove of major therapeutic and prognostic advantage.

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 ten previously published cases
• Who was studied: One 30-year-old man with right scrotal swelling, treated at Montefiore Hospital and Medical Center, Bronx, New York; plus ten previously published cases from the literature
• Exposure: Eight years of work as a pipefitter at an oil refinery, ending two years before admission. The work involved placing thick asbestos insulation around large pipelines and straddling the pipes. The fiber type was not specified.
• Main results:
  • In this patient, cytologic examination of the aspirated hydrocele fluid showed malignant carcinomatous mesothelioma before surgery
  • In this patient, tumor cells showed a strong positive immunoperoxidase reaction for mesothelial cell antigens
  • In this patient, electron microscopy showed many slender microvilli of variable length and configuration on the tumor cells
  • No asbestos bodies were found in this patient's hydrocele fluid smears or cell block
  • No asbestos bodies or asbestos fibers were found in 1.3 g of this patient's tumor tissue after digestion
  • After surgery, this patient's scans were negative for metastatic disease, and at six months he was well without clinical evidence of disease
  • Among the eleven reviewed cases (including this one), occupational history was sought in five, and two (Case 8 and this case) reported asbestos exposure
  • Patients in the reviewed cases were aged 21 to 78 years
  • This patient's first asbestos exposure was only ten years before diagnosis. The authors wrote that this probably does not negate a causal relationship.
  • Cytologic examination of hydrocele fluid was not recorded in any of the previously reported cases
• The authors' conclusion: The authors concluded that early diagnosis by cytologic examination of hydrocele fluid may prove to be of major therapeutic and prognostic advantage
• Limitations the authors state:
  • The authors noted that the effectiveness of cytologic evaluation of hydrocele fluid has not been established
  • The authors described their criteria for selecting earlier cases from the literature as arbitrary

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Hydrocele, Mesothelial Cells.

Related studies

• Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology — S.C. Gupta, A.K. Gupta, et al. (1998)
• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)
• 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)
• Biphasic malignant mesothelioma of the tunica vaginalis testis — K.C. Saw, T.H. Barker, et al. (1994)
• Papillary serous carcinoma of the tunica vaginalis testis — P. Becerra, M.A. Isaac, et al. (2000)
• 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)

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