Mesothelioma of tunica vaginalis testis and asbestos exposure

Our plain-English summary of Mesothelioma of tunica vaginalis testis and asbestos exposure, by C. Mensi, M. Pellegatta, C. Sieno, et al (BJU International, 2012).

The study

• Authors: C. Mensi, M. Pellegatta, C. Sieno, D. Consonni, L. Riboldi, P.A. Bertazzi
• Journal: BJU International
• Published: 2012;110(4):533-7
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Unlabelled: Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? Mesothelioma of the tunica vaginalis testis is a rare tumour. From 2000 to 2010, 13 mesothelioma of the tunica vaginalis testis cases were reported in the most populated and industrialized region in Italy. Asbestos exposure was documented in two-thirds of these cases.

Objective: • To describe cases of mesothelioma of the tunica vaginalis testis (MTVT) recorded in the Lombardy Mesothelioma Registry between 2000 and 2010.

Methods: • The Lombardy Mesothelioma Registry, established in 2000, collects data regarding all incident cases of mesothelioma of the pleura, peritoneum, pericardium and tunica vaginalis testis that have been diagnosed in the population of the Lombardy region. • These data include a detailed clinical report and a complete occupational history for each MTVT patient, with the latter including details of the industrial sector involved, the patient's job, and the specific tasks performed. To address the potential for asbestos exposure outside the work environment, the residential history, lifestyle habits and hobbies of the patient, as well as job information for all subjects living with the patient, are also collected. • Records were reviewed and discussed by a panel of experts.

Results: • Thirteen cases of MTVT were reported between 2000 and 2010. • The age-standardized incidence rate of MTVT for the Lombardy region of Italy is 0.2 cases per million individuals/year. • Asbestos exposure was documented in 8 of the 12 (67%) interviewed cases.

Conclusions: • Asbestos exposure was associated with a higher proportion of MTVT cases than previously reported in the literature. These results confirm the aetiological role for asbestos in the pathogenesis of MTVT. • The results of this study also highlight the importance of obtaining detailed occupational histories and lifestyle habits from patients, particularly by trained interviewers.

© 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

In plain English

This case series described all 13 cases of mesothelioma of the tunica vaginalis testis (the membrane lining around the testicle) reported to the Lombardy Mesothelioma Registry in northern Italy between 2000 and 2010. These 13 cases made up 0.4% of the 3488 mesothelioma cases recorded there. Trained interviewers gave patients or their next of kin a standardized questionnaire about work, homes, lifestyle and hobbies. Patients were aged 38 to 85 at diagnosis. The most common first sign was hydrocele (fluid around the testicle), in 8 of 13 cases. Of the 12 cases with complete interviews, asbestos exposure was documented in 8 (67%). Six were exposed through work, including maintenance workers in plants with asbestos-insulated pipes and bricklayers using asbestos-cement. One was exposed through his father's work clothes and one through ironing at home on a board containing asbestos. For four cases, exposure could not be assessed. Median survival was 20.0 months. The authors concluded that asbestos exposure was associated with a higher share of these cases than earlier literature reported, which they said confirmed a causal role for asbestos.

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 series drawn from a population-based mesothelioma registry
• Who was studied: All 13 cases of mesothelioma of the tunica vaginalis testis reported to the Lombardy Mesothelioma Registry (Lombardy region, northern Italy, over 9 million inhabitants) between 2000 and 2010
• Exposure: Asbestos exposure assessed by a standardized questionnaire covering occupational, residential, lifestyle and household history. Exposures included occupational work (maintenance in plants with asbestos-insulated pipes, bricklaying with asbestos-cement), a father's work clothes, and ironing on an asbestos-containing board. No fiber types were named.
• Main results:
  • The 13 cases represented 0.4% of the 3488 malignant mesothelioma cases reported to the registry for both sexes
  • Age-standardized incidence rates were 0.3, 0.2 and 0.1 per million per year, using the Italy 2001, Europe and World standard populations respectively
  • Age at diagnosis ranged from 38 to 85 years, with a median of 74.0 years
  • Hydrocele was the clinical onset in 8 of 13 cases (61%)
  • Of the 12 cases with complete interview data, asbestos exposure was documented in 8 (67%)
  • Exposure was documented in 6 of 8 (75%) cases interviewed directly and in 2 of 4 (50%) cases interviewed through next of kin; the difference was not statistically significant (P = 0.39)
  • Five occupationally exposed cases directly used asbestos-containing products; one more was exposed indirectly at work, where asbestos was used as insulation
  • Two cases had exposure outside work: one through his father's work clothes from a thermo-electric plant, one through regular ironing at home on an asbestos-coated board
  • In four cases the available information did not allow exposure to be assessed, so exposure was classified as unknown
  • No patient had pleural plaques or asbestosis
  • Among occupationally exposed patients, median latency from first exposure to diagnosis was 51.9 years (mean 46.2, range 16.2 to 59.7)
  • Median duration of occupational exposure was 26.5 years (mean 23.8, range 10.0 to 32.0)
  • Median survival was 20.0 months (mean 24.1 months); two patients were alive at last follow-up in 2011
  • Survival probability was 0.75 (95% CI 0.41 to 0.91) at 1 year and 0.50 (95% CI 0.21 to 0.74) at 2 years
  • Cases aged 70 or older at diagnosis and cases with epithelial mesothelioma had a worse prognosis, but the differences were not statistically significant (P = 0.10 and P = 0.07)
• The authors' conclusion: The authors concluded that asbestos exposure was associated with a higher proportion of these cases than previously reported in the literature, and that the results confirm an aetiological (causal) role for asbestos. They added that the results highlight the importance of detailed occupational and lifestyle histories taken by trained interviewers.
• Limitations the authors state:
  • The authors had no information on chemotherapy or radiotherapy after orchidectomy

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Asbestos Exposure, Pleura, Peritoneum, Pericardium, Occupational History, Habit.

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• Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register — L. Vimercati, D. Cavone, et al. (2019)
• Malignant mesothelioma of tunica vaginalis testis — G. Tyagi, C.S. Munn, et al. (1989)
• Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2017)
• Imaging of mesothelioma of tunica vaginalis testis — M. Bertolotto, I. Boulay-Coletta, et al. (2016)

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