Mesothelioma of the Tunica Vaginalis Testis: Diagnostic and Therapeutic Management. A Comprehensive Review, 1982-2024

Our plain-English summary of Mesothelioma of the Tunica Vaginalis Testis: Diagnostic and Therapeutic Management. A Comprehensive Review, 1982-2024, by S. Stella, G.L. Ceresoli, B. Dallari, et al (Cancers, 2024).

The study

• Authors: S. Stella, G.L. Ceresoli, B. Dallari, R. Barile, F. Maisenti, S. Rugarli, A. Marinaccio, D. Consonni, C. Mensi
• Journal: Cancers
• Published: 2024;16(23)
• Type of article: Review
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma of the tunica vaginalis testis (MTVT) is an extremely rare and aggressive cancer. The diagnosis and management of MTVT is complex, and no standard treatment protocol is available.

Methods: We conducted a systematic literature review from 1 January 1982 to 14 March 2024 using PubMed to collect all the available case reports and case series. A descriptive analysis of patient characteristics with clinical presentation, diagnostic work-up, therapeutic management, and past asbestos exposure was performed. Survival times of patients treated with different therapeutic approaches were evaluated.

Results: Overall, 289 patients with MTVT were included in our analysis. The most common clinical presentations were scrotal/testicular swelling or mass (187 patients, 65%) and the presence of hydrocele (159, 55%). Imaging evaluation, mostly with ultrasonography or CT scan, was reported in two-thirds of cases. Radical surgery (216 patients, 75%) with orchiectomy and, in select cases, hemiscrotectomy and inguinal lymphadenectomy was the most frequent therapeutic approach. A minority of patients (49, 17%) received adjuvant therapy after surgery (radiotherapy, chemotherapy, or a combination of the two), with no evidence of survival improvement.

Conclusions: No standard guidelines for MTVT are available so far. Radical surgery following accurate radiological staging should be the mainstay of treatment. The role of adjuvant treatments remains undefined. Due to its rarity, MTVT should be treated in referral centers, and patients' data should be collected in a dedicated register in order to improve the knowledge of this exceedingly rare disease and establish optimal diagnostic and therapeutic management.

In plain English

This article was a review of published case reports and case series on mesothelioma of the tunica vaginalis testis (MTVT), a rare cancer of the lining around the testicle. The authors searched PubMed for English-language articles published from 1 January 1982 to 14 March 2024 and included 159 papers describing 289 patients. The median age was 62 years, ranging from 6 to 93. Previous asbestos exposure was reported in 71 of the 200 patients with available information (36%), mostly occupational (52 of 200, 26%). The most frequent presentations were scrotal or testicular swelling or mass (161 cases), hydrocele (159 cases) and pain (33 cases). Radical inguinal orchiectomy was performed in 216 patients (75%). Forty-nine patients received chemotherapy, radiotherapy or both after surgery. Median survival was similar in patients treated with surgery only and in those who also received adjuvant treatment (p-value 0.59). The authors said this comparison should be interpreted with caution because few patients received adjuvant treatment. Relapse was reported in 120 cases (42%). The authors concluded that timely extensive surgery is the standard of care and that the role of adjuvant treatments is not defined.

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: Review of published case reports and case series. The authors call it a systematic literature review in the methods and a narrative review in the simple summary.
• Who was studied: 289 patients with mesothelioma of the tunica vaginalis testis, described in 159 English-language papers found in PubMed and published from 1 January 1982 to 14 March 2024. The patients' median age was 62 years (range 6 to 93).
• Exposure: Past asbestos exposure as reported in the case reports. Fiber types are not specified. Of 200 patients with available information, 71 (36%) had reported exposure, mostly occupational (52 of 200, 26%). Information was not available for 89 patients.
• Main results:
  • Among the 289 patients, the most frequent clinical presentations were scrotal/testicular swelling and/or mass (161 cases, 56%), hydrocele (159 cases, 55%) and pain (33 cases, 11%).
  • Pre-surgical imaging was reported in 195 of 289 cases (68%).
  • 60% of cases had epithelioid morphology. In Table 3, 174 of 289 (60.2%) were epithelioid, 65 (22.5%) biphasic, 4 (1.4%) fibrous or sarcomatoid and 46 (15.9%) unspecified.
  • Radical inguinal orchiectomy was performed in 216 of 289 patients (75%). Of these, 25 (9%) had more extended surgery with hemiscrotectomy and inguinal lymphadenectomy.
  • 49 patients received adjuvant therapy: chemotherapy or radiotherapy in 42 (15%) and both modalities in 7 (2%).
  • Median survival was similar in patients treated with surgery only and in those treated with surgery plus adjuvant therapy. Table 4 lists 24 months for each group. Survival data were available for 176 of 233 surgery-only patients and 43 of 49 adjuvant-treated patients.
  • The survival comparison between the two treatment groups gave a p-value of 0.59 (Wilcoxon/Mann–Whitney test).
  • Disease relapse was reported in 120 of 289 cases (42%): distant metastases in 102 (35%) and local recurrence in 18 (6%).
• The authors' conclusion: The authors concluded that timely extensive surgical treatment is the standard of care, that the role of adjuvant treatments is not defined, and that patients should ideally be referred to centers with expertise in this disease. They also called for a national MTVT registry.
• Limitations the authors state:
  • Because few patients received adjuvant treatment, no test of heterogeneity was performed.
  • The comparison between patients treated with surgery alone and those receiving any adjuvant treatment should be interpreted with caution.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Systematic Review, Asbestos Exposure, Hydrocele, CT Scan, Orchiectomy, Hemiscrotectomy.

Related studies

• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)
• Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks — A. Marinaccio, D. Consonni, et al. (2020)
• Authors' response: Mezei et al's "Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis" — A. Marinaccio, D. Consonni, et al. (2021)
• Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis — S.S. Chekol, C.C. Sun (2012)
• Mesothelioma of tunica vaginalis testis and asbestos exposure — C. Mensi, M. Pellegatta, et al. (2012)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)

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