Malignant mesothelioma of tunica vaginalis testis: Report of a very rare case with review of the literature

Our plain-English summary of Malignant mesothelioma of tunica vaginalis testis: Report of a very rare case with review of the literature, by E. Trenti, S.M. Palermo, C. D'Elia, et al (Archivio Italiano di Urologia, Andrologia, 2018).

The study

• Authors: E. Trenti, S.M. Palermo, C. D'Elia, E. Comploj, A. Pycha, R. Carella, A. Pycha
• Journal: Archivio Italiano di Urologia, Andrologia
• Published: 2018;90(3):212-214
• Type of article: Case report, Review
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Mesothelioma of the tunica vaginalis testis is a extremely rare tumor and represents 0.3 to 0.5% of all malignant mesotheliomas. Exposure to asbestos often precedes illness. Because of its low incidence and nonspecific clinical presentation, it is mostly diagnosed accidentally during surgery for other reasons and the prognosis is usually poor. We present a case of a patient with a mesothelioma of tunica vaginalis testis, diagnosed secondarily during hydrocele surgery, with long-term survival after radical surgery.

Materials And Methods: a 40 years old patient was admitted to our department for routine surgery of a left hydrocele. During the operation a frozen section analysis was requested because of the unusual nodular thickening of the tunica vaginalis: the examination revealed a diffuse malignant mesothelioma with epithelioid structure and tubular-papillary proliferation. Therefore a left hemi-scrotectomy with left inguinal lymph node dissection was performed.

Results: The definitive histology confirmed the previous report of diffuse malignant mesothelioma with angio-invasion but normal testicle findings and negative lymph nodes. No metastases were found on the CT-scan. For the first 2 years a CT was repeated every 4 months, for other 3 years every 6 months and then yearly. Six years after surgery the patient is classified as no evidence of disease.

Conclusions: malignant mesothelioma of the tunica vaginalis testis is a rare entity, often initially thought to be a hydrocele or an epididymal cyst. An aggressive approach with hemiscrotectomy with or without inguinal and retroperitoneal lymphadenectomy can reduce the risk of recurrence.

In plain English

This article was a case report from the Department of Urology of the General Hospital of Bolzano, Italy, followed by a discussion of earlier published reports. It described a 40-year-old patient admitted for routine surgery on a left hydrocele, a collection of fluid around the testis. During the operation the surgeon noticed an unusual fibrotic thickening of the tunica vaginalis, the lining around the testis, and asked for tissue testing. The tissue showed a diffuse malignant mesothelioma with epithelioid structure. A CT scan found no distant spread but modestly enlarged left groin lymph nodes up to 22 mm. The patient then had a left hemiscrotectomy (removal of one side of the scrotum) with removal of the left groin lymph nodes. The testis was normal and the lymph nodes were negative. No additional (adjuvant) therapy was given. Six years after surgery the patient showed no signs of recurrent disease. An occupational physician could not demonstrate asbestos exposure in this patient. The authors concluded that this tumor should always be suspected in patients with asbestos exposure and rapid enlargement of one side of the scrotum.

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 of a single patient, with a discussion of the published literature
• Who was studied: One 40-year-old patient admitted for left hydrocele surgery to the Department of Urology, General Hospital of Bolzano, Italy. The dates of treatment are not given.
• Exposure: No asbestos exposure could be demonstrated for this patient by the occupational physician
• Main results:
  • Tissue examination showed a diffuse malignant mesothelioma with epithelioid structure and tubular-papillary proliferation
  • CT showed no distant metastases, with modest enlargement of the left inguinal (groin) lymph nodes up to 22 mm
  • After left hemiscrotectomy with left inguinal lymph node dissection, the testis was normal and the lymph nodes were negative
  • Adjuvant therapy was not indicated for this patient
  • Six years after surgery the patient showed no signs of recurrent disease
• The authors' conclusion: The authors concluded that mesothelioma of the tunica vaginalis testis should always be suspected in patients with asbestos exposure and rapid enlargement of one side of the scrotum.

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, Prognosis, Hydrocele, Frozen Section, Epithelioid, Histology, Hemiscrotectomy.

Related studies

• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)
• 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)
• Extremely rare tumour--malignant mesothelioma of tunica vaginalis testis — T. Jankovichova, M. Jankovich, et al. (2015)
• 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)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Papillary serous carcinoma of the tunica vaginalis testis — P. Becerra, M.A. Isaac, et al. (2000)

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