Malignant mesotheliomas in spermatic cords: reports of two cases and a brief review of literature

Our plain-English summary of Malignant mesotheliomas in spermatic cords: reports of two cases and a brief review of literature, by X. Meng, T.J. Guzzo, Z. Bing (Rare Tumors, 2013).

The study

• Authors: X. Meng, T.J. Guzzo, Z. Bing
• Journal: Rare Tumors
• Published: 2013;5(1):e4
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary malignant mesothelioma (MM) of spermatic cord is extremely rare. We presented two malignant mesotheliomas involving the spermatic cords; one was primary, one secondary. The secondary one represented the direct involvement by a peritoneal MM. No occupational exposure to asbestos was identified in either patient. Both of them presented with a painless inguinal mass. Microscopically the primary MM was epithelioid type with tumor nests infiltrating adjacent adipose tissue, while the secondary MM grew in mixed type. No tumor necrosis was seen in the primary MM, while extensive necrosis was seen in the secondary one. Rare mitotic figure was seen in the primary MM while the mitosis in the secondary tumor was brisk, and with atypical mitosis. Immunohistochemically the tumor cells were positive for calretinin and CK5/6 and negative for BER-EP4 and BRST3 in both cases. The reported cases of primary MM from spermatic cord in English literature were briefly reviewed.

In plain English

This article reported two cases and briefly reviewed earlier published cases. The authors, at the Hospital of the University of Pennsylvania, searched their pathology department's database and found two malignant mesotheliomas involving the spermatic cord. In a 45-year-old Caucasian man, the tumor arose in the spermatic cord itself (primary). It was epithelioid type with no necrosis and only occasional dividing cells. This patient had no known asbestos exposure and was alive without evidence of disease 6 months after surgery. In a 68-year-old man, the tumor was a peritoneal mesothelioma spreading to the spermatic cord (secondary). It was mixed type with extensive necrosis and brisk cell division, and the patient was lost to follow-up. The article states that no occupational asbestos exposure was identified in either patient. Both tumors stained positive for calretinin and CK5/6. The authors reviewed 10 primary cases (9 published plus their own). Six of these had asbestos exposure information, and none was positive. The authors concluded these are aggressive tumors, with 57% of reported patients having recurrence within 2 years. They said too few cases exist to estimate a meaningful mortality rate.

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: Two case reports with a brief review of published cases
• Who was studied: Two men whose cases were found in the University of Pennsylvania pathology database: a 45-year-old Caucasian man with primary spermatic cord mesothelioma (case 1) and a 68-year-old man with a history of intra-abdominal mesothelioma involving the spermatic cord (case 2). The review covered 10 primary cases: 9 published cases plus case 1. Dates were not given.
• Exposure: No occupational asbestos exposure was identified in either patient. Case 1 had no known history of asbestos exposure. No fiber type or product was studied.
• Main results:
  • Case 1 (primary): the tumor was epithelioid type, with tumor nests infiltrating adjacent fat tissue around the vas deferens. No necrosis was seen.
  • Case 1 had no radiation or chemotherapy and was alive without evidence of disease 6 months after surgery.
  • Case 2 (secondary, from peritoneal mesothelioma): the tumor was mixed type with extensive necrosis and brisk mitosis (about 19 per 10 high-power fields), including atypical mitosis.
  • Case 2 was lost to follow-up after surgery.
  • In both cases the tumor cells were positive for calretinin and CK5/6 and negative for Ber-EP4 and BRST3.
  • Review: 10 primary spermatic cord mesotheliomas were identified (9 from the literature plus case 1). Patient ages ranged from 26 to 74 years, with an average of 47.
  • Review: six of the 10 cases had information on asbestos exposure, and none was positive.
  • Review: seven cases gave a tumor type. Five were epithelioid and 2 were mixed.
  • Review: 57% of the reported primary spermatic cord cases had recurrence within 2 years.
• The authors' conclusion: The authors concluded that primary mesotheliomas of the spermatic cord are aggressive tumors capable of local recurrence and of spread through the lymph and blood. They stated that tumors elsewhere (peritoneum, chest cavity) must be excluded before diagnosing a primary spermatic cord mesothelioma.
• Limitations the authors state:
  • The authors stated that too few primary spermatic cord cases have been reported to estimate a meaningful mortality rate or prognostic factors.

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Spermatic Cord, Occupational Exposure, Epithelioid, Necrosis, Calretinin, Ber-EP4.

Related studies

• Treatment of malignant tumors of the spermatic cord: a study of 10 cases and a review of the literature — P.H. Blitzer, D.E. Dosoretz, et al. (1981)
• Tumors of the spermatic cord: a review of the literature and a report of a case of lymphangioma — A.A. el-Badawi, M.M. al-Ghorab (1965)
• Malignant mesothelioma of the spermatic cord — Y.J. Park, H.J. Kong, et al. (2011)
• Mesothelioma of spermatic cord: electron microscopic and histochemical characteristics of its mucopolysaccharides — P. Pizzolato, J. Lamberty (1976)
• Malignant Mesothelioma of Spermatic Cord in an Elderly Man With a History of Asbestos Exposure — A. D'Antonio, F. Mastella, et al. (2016)
• Carcinosarcoma of the spermatic cord — M. Nistal, F. Burgos, et al. (1990)

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