Mesothelioma of the tunica vaginalis testis

Our plain-English summary of Mesothelioma of the tunica vaginalis testis, by K.J. Butnor, E.N. Pavlisko, T.A. Sporn, et al (Human Pathology, 2019).

The study

• Authors: K.J. Butnor, E.N. Pavlisko, T.A. Sporn, V.L. Roggli
• Journal: Human Pathology
• Published: 2019;92:48-58
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM) arising from the serosal membranes of the tunica vaginalis testis (TVT) is rare. Most examples in the published medical literature are individual case reports. This study presents the clinicopathological findings of mesothelioma of the TVT in one of the largest series to date. Individuals with mesothelioma of the TVT were identified from a database of more than 4000 mesothelioma cases, and their clinicopathological features were recorded. Eighteen men with MM and 2 with well-differentiated papillary mesothelioma of the TVT were identified, which represented 0.6% of males with mesothelioma in study population. The median age at diagnosis was 72 years (range, 32-85 years). A neoplasm was not suspected preoperatively in 12 of the 17 (71%) men whose clinical presentation was known, 7 of whom presented with hydrocele and 5 with inguinal hernia. The other 5 had a clinically recognized mass. Seven of the men underwent herniorrhaphy; 7, radical orchiectomy; 3, hydrocelectomy; and 3, paratesticular mass biopsy or excision as the initial diagnostic procedure. Twelve of the MM cases were epithelioid and 6 were biphasic. Among the 6 men with MM who had ≥6 months of follow-up, 1 was alive with no evidence of disease at 6 months, and 5 were known to have died of disease 8-74 months (median = 31.5 months) following diagnosis. Three men with MM had received either chemotherapy or radiation therapy. Of the 2 men initially diagnosed with well-differentiated papillary mesothelioma, 1 was alive without evidence of disease 5 years after diagnosis, while the other had findings more compatible with MM with peritoneal involvement 2 years following initial diagnosis. In 15 of the 18 cases of MM (83%), there was documented occupational or paraoccupational exposure to asbestos, the average duration of which was 33 years (range, 2-46 years). Information regarding the presence or absence of pleural plaques was available in 5 of the MM cases, and pleural plaques had been found in 4. Lung tissue was not available for fiber analysis in any of the cases. One additional case originally diagnosed at another institution as MM of the TVT was reclassified as adenocarcinoma following performance of additional immunohistochemical testing. TVT is a rare site of MM, the diagnosis of which is often unsuspected preoperatively. Like its counterparts at other serosal sites, MM of the TVT is an aggressive tumor with a poor prognosis that evidence would suggest is etiologically associated with asbestos in at least some cases.

Copyright © 2019 Elsevier Inc. All rights reserved.

In plain English

The authors searched a database of more than 4000 mesotheliomas received in professional and medicolegal consultation. They found 18 men with malignant mesothelioma and 2 with well-differentiated papillary mesothelioma of the tunica vaginalis testis (the lining around the testis). These were 0.6% of the men with mesothelioma in the database. Median age at diagnosis was 72 years. Before surgery, a tumor was suspected in only 5 of the 17 men whose presentation was known; many presented with hydrocele or inguinal hernia. Of 6 men with malignant mesothelioma and at least 6 months of follow-up, 5 were known to have died of the disease. Occupational or paraoccupational asbestos exposure was documented in 15 of the 18 malignant cases (83%). Pleural plaques were found in 4 of the 5 malignant cases with that information. No lung tissue was available for fiber analysis. The authors concluded that evidence would suggest the tumor is associated with asbestos in at least some cases. They noted that because the database is medicolegal, asbestos-related cases could be over-represented.

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: Retrospective case series drawn from a pathology consultation database
• Who was studied: 18 men with malignant mesothelioma (MM) and 2 men with well-differentiated papillary mesothelioma (WDPM) of the tunica vaginalis testis. Their cases were reviewed in consultation between 1987 and 2017. They were drawn from a database of 3589 men with mesothelioma and made up 0.6% of the males in it.
• Exposure: Documented occupational or paraoccupational asbestos exposure. The table lists jobs such as US Navy, shipyard work, construction, auto mechanic, insulation manufacturing, vermiculite insulation manufacturing and oil refinery work, plus household contact with oil refinery workers in one WDPM case. Fiber type was not measured. Based on occupational histories, the authors said some men had the potential for exposure to commercial amphibole asbestos.
• Main results:
  • Median age at diagnosis was 72 years (range 32 to 85) for all 20 men. This was similar to men in the database with pleural mesothelioma (P = .65) and significantly older than men with peritoneal mesothelioma (P = .007).
  • Clinical presentation was known for 17 men. Only 5 (29%) were suspected of having a tumor before surgery. Common presentations were hydrocele (7), a mass (5) and inguinal hernia (5).
  • Of the 18 MM cases, 12 were epithelioid and 6 were biphasic.
  • Six men with MM had at least 6 months of follow-up. One was alive with no evidence of disease at 6 months, and 5 were known to have died of disease. Survival time was known for 4 of the men who died and ranged from 8 to 74 months (median 31.5 months).
  • Of the 2 men with WDPM, 1 was alive without evidence of disease 5 years after diagnosis. The other had findings more compatible with MM, with peritoneal involvement, 2 years after the initial diagnosis.
  • Asbestos exposure was documented in 15 of 18 MM cases (83%). The average duration of exposure was 33 years (range 2 to 46 years).
  • Information on pleural plaques was available for 5 MM cases, and plaques were found in 4. Applying the Helsinki criteria, the authors said 4 of the 18 MM cases (22%) would be attributable to asbestos based on pleural plaques.
  • No case had a documented radiographic diagnosis of asbestosis, and no lung tissue was available for fiber analysis.
  • One additional case diagnosed elsewhere as MM of the tunica vaginalis testis was reclassified as adenocarcinoma after further immunohistochemical testing.
• The authors' conclusion: The authors concluded that MM of the tunica vaginalis testis is a rare, aggressive tumor with a poor prognosis. They said evidence would suggest it is associated with asbestos in at least some cases.
• Limitations the authors state:
  • Because the database comes from medicolegal consultation, asbestos-related cases may be overrepresented.
  • Clinical records on treatment and survival were limited.
  • No meaningful conclusions about treatment could be drawn.
  • No lung tissue was available for fiber analysis in any case.
  • Some cases were evaluated before routine immunohistochemistry, and their tissue blocks were no longer available for further testing.

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, Malignant Mesothelioma, Well-Differentiated Papillary Mesothelioma, Neoplasm, Hydrocele, Inguinal Hernia, Orchiectomy.

Related studies

• Mesothelioma of the tunica vaginalis testis: report of 2 cases with asbestos occupational exposure — G. Gorini, M. Pinelli, et al. (2005)
• 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)
• Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2017)
• Mesothelioma of the tunica vaginalis: a series of eight cases with uncertain malignant potential — F. Brimo, P.B. Illei, et al. (2010)
• Preoperative cytological diagnosis of malignant mesothelioma of tunica vaginalis — A. Bandyopadhyay, S. Bhattacharya, et al. (2015)
• Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis — S.S. Chekol, C.C. Sun (2012)

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