Paratesticular mesothelioma. Report of a case with comprehensive review of literature

Our plain-English summary of Paratesticular mesothelioma. Report of a case with comprehensive review of literature, by M. Bisceglia, D.B. Dor, I. Carosi, et al (Advances in Anatomic Pathology, 2010).

The study

• Authors: M. Bisceglia, D.B. Dor, I. Carosi, M. Vairo, G. Pasquinelli
• Journal: Advances in Anatomic Pathology
• Published: 2010;17(1):53-70
• Type of article: Case report, Review
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Paratesticular mesotheliomas are rare tumors with 223 cases described so far. The sole plausible causative factor so far ascertained in the pathogenesis of these tumors is asbestos, which however is found in only around 30% to 40% of such cases. The age range of affected individuals is wide, mostly adults and the elderly, but also includes young people and children. The most common presenting symptom is either hydrocele of unknown origin or intrascrotal mass. When hydrocele is the presenting symptom, these tumors are often clinically overlooked and the diagnosis is delayed. Most paratesticular mesotheliomas arise in the tunica vaginalis, but primary tumors of the spermatic cord and epididymis are also on record. Tumors arising from the peritoneal mesothelium of a hernia sac are excluded from this group. The correct diagnosis is almost always made after histologic examination of the operative specimen. Immunohistochemistry and electron microscopy are always helpful and sometimes necessary tools for diagnosis. So far very few cases have been identified or suspected preoperatively on cytologic examination. Three clinicopathologic types of malignant mesotheliomas of the male genital tract are recognized: diffuse tubulo-papillary mesothelioma, well-differentiated papillary mesothelioma, and multicystic mesothelioma. The histologic subtypes are almost always pure epithelial or biphasic. The differential diagnosis is mainly with serous papillary tumors arising from Mullerian vestiges, but several diverse primary or secondary tumors also need to be considered. A clinicopathologic evaluation of a case of tunical diffuse mesothelioma in a 74-year-old male from the AMR Series is the starting point for this general review.

In plain English

This article reported one patient and reviewed published cases of paratesticular mesothelioma, a rare tumor arising around the testis. The patient was a 74-year-old man seen at a hospital in San Giovanni Rotondo, Italy, in December 2000. His right testis was removed, and he was diagnosed with malignant mesothelioma of the tunica vaginalis testis, epithelial subtype. The patient denied any past asbestos exposure. After 2 years free of disease, the tumor came back locally several times and spread to lymph nodes, the lungs and the skin. At the time of writing the patient was severely debilitated. The authors counted at least 223 cases described up to 2009. Among the 60 cases they tabulated from June 2002 to September 2009, hydrocele was the main presenting symptom in 26 and a scrotal mass in 22. Drawing on earlier reviews and their table, the authors wrote that occupational or familial asbestos exposure is found in around 35% to 40% of cases. They noted that exposure information may not always have been adequate. They concluded these tumors should be suspected even without a history of asbestos exposure.

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 one patient combined with a literature review of published paratesticular mesothelioma cases
• Who was studied: One 74-year-old male patient admitted in December 2000 to the Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy, with right testicular pain; plus published cases from the literature from 1957 to September 2009
• Exposure: The patient denied any past asbestos exposure; no fiber types are given for this case
• Main results:
  • The patient's diagnosis was malignant mesothelioma (epithelial subtype) of the tunica vaginalis testis
  • Electron microscopy of the patient's tumor showed numerous slender microvilli of the mesothelioma type
  • After surgery the patient remained free of disease for 2 years, then developed tumor nodules on the right scrotal skin
  • The patient later had mediastinal and bilateral lung metastases
  • At the time of writing the patient was severely debilitated
  • The literature review counted at least 223 paratesticular mesothelioma cases described up to 2009
  • Among 60 cases tabulated from June 2002 to September 2009, hydrocele was the main presenting symptom in 26 and scrotal mass in 22, with both in 3
  • Citing earlier reviews and their table, the authors stated that a history of direct occupational or familial asbestos exposure is found in around 35% to 40% of cases, with no such exposure reported in the majority
• The authors' conclusion: The authors concluded that, despite their rarity, tunical and other paratesticular mesotheliomas need to be suspected even without a history of asbestos exposure, and in all cases of hydrocele of unknown cause
• Limitations the authors state:
  • The authors note that information on asbestos exposure in published cases may not always have been adequate
  • The case tabulation included only cases with adequate clinicopathologic description in pathology journals

Topics

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

Medical terms in this study, explained in our Lexicon: Testicular Mesothelioma, Hydrocele, Tunica Vaginalis, Spermatic Cord, Epididymis, Mesothelium, Immunohistochemistry, Malignant Mesothelioma.

Related studies

• Adult paratesticular tumours — B. Khoubehi, V. Mishra, et al. (2002)
• Paratesticular malignant mesothelioma associated with abdominoscrotal hydrocele — A.L. Velasco, J. Ophoven, et al. (1988)
• Paratesticular papillary mesothelioma — R. Linn, B. Moskovitz, et al. (1988)
• Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA — S.J. Lowry, N.S. Weiss (2016)
• Immunohistochemical profile of paratesticular serous papillary adenocarcinoma and tunica vaginalis facilitates distinction from malignant mesothelioma — P.R. Anchala, R. Dhir, et al. (2011)
• Paratesticular malignant mesothelioma in a patient exposed to asbestos for more than 50 years — L.N. Hsu, M.T. Sung, et al. (2014)

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