Malignant mesothelioma of tunica vaginalis testis

Our plain-English summary of Malignant mesothelioma of tunica vaginalis testis, by K.T. Chen, R.B. Arhelger, M.S. Flam, et al (Urology, 1982).

The study

• Authors: K.T. Chen, R.B. Arhelger, M.S. Flam, J.H. Hanson
• Journal: Urology
• Published: 1982;20(3):316-9
• Type of article: Case report
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case of biphasic malignant mesothelioma of the tunica vaginalis occurring in a sixty-four-year-old man is described. The tumor metastasized widely and led to the patient's death two and one-half years after diagnosis. Review of the literature revealed 7 cases of malignant mesothelioma of tunica vaginalis. These tumors appeared highly aggressive with early onset of metastasis. Histologically, the tumors may be epithelial, fibrous, or biphasic. In contrast to the benign variants of mesotheliomas, these tumors often show significant nuclear atypia, mitotic activity, and invasion of the epididymis, spermatic cord, lymphatic spaces, or the fibrous tissue of the tunica.

In plain English

This article was a case report with a short review of earlier published cases. The authors described a 64-year-old American Indian man with a one-year history of growing swelling on the right side of the scrotum. Doctors first thought it was a hydrocele, a collection of fluid. At surgery the sac was covered with small nodules, and the sac and testis were removed. Under the microscope the tumor was biphasic, meaning it contained both epithelial and spindle-cell tissue, and it had invaded the epididymis. Two outside pathologists diagnosed malignant mesothelioma of the tunica vaginalis, the lining around the testis. About two years later the cancer had spread to his lungs, liver and lymph nodes. Chemotherapy with doxorubicin and vincristine briefly shrank some tumors, and cyclophosphamide was ineffective. He died two and one-half years after diagnosis. The article does not say whether this patient was exposed to asbestos. Of the 7 earlier cases the authors reviewed, one patient had a history of asbestos exposure. The authors concluded that these tumors seemed highly aggressive.

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 review of previously reported cases
• Who was studied: One 64-year-old American Indian man with malignant mesothelioma of the tunica vaginalis testis, compared with 7 previously reported cases from the literature
• Exposure: Asbestos exposure is not mentioned for this patient. Among the 7 previously reported cases reviewed, one patient had a history of asbestos exposure (no fiber type given) and another had local trauma fifteen years earlier.
• Main results:
  • The patient had progressive right scrotal swelling, which was clinically thought to be a hydrocele.
  • The tumor was biphasic, with epithelial and spindle-cell tissue, and had invaded the epididymis.
  • Two consultant pathologists reviewed the slides and both diagnosed malignant mesothelioma.
  • About two years after surgery, the patient had metastases, including multiple lung nodules.
  • Doxorubicin and vincristine chemotherapy produced a temporary shrinkage of the supraclavicular and lung metastases; cyclophosphamide was ineffective. The patient died two and one-half years after diagnosis.
  • Across the 8 cases (7 reviewed plus this one), all patients were adults, with a mean age of sixty-two years at diagnosis.
  • Of the 8 cases, the tumor was pure epithelial in 4, predominantly fibrous in 1, and biphasic in 3.
  • Five of the 8 patients had metastases. Of these 5, 3 died of widespread tumor within three years.
• The authors' conclusion: The authors concluded that malignant mesotheliomas of the tunica vaginalis seemed to behave highly aggressively.
• Limitations the authors state:
  • The authors stated that the role of radiation treatment could not be assessed because too few cases were available.
  • The authors noted that the 2 patients without metastasis or local recurrence had been followed for only several months.

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, Biphasic Mesothelioma, Metastasis, Mesothelioma, Nuclear Atypia, Epididymis, Spermatic Cord.

Related studies

• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)
• Retroperitoneal lymph node dissection in malignant mesothelioma of tunica vaginalis testis — J.J. Smith, M.J. Malone, et al. (1990)
• 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)

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