Paratesticular papillary mesothelioma

Our plain-English summary of Paratesticular papillary mesothelioma, by R. Linn, B. Moskovitz, M. Bolkier, et al (Urologia Internationalis, 1988).

The study

• Authors: R. Linn, B. Moskovitz, M. Bolkier, M. Munichor, D.R. Levin
• Journal: Urologia Internationalis
• Published: 1988;43(1):60-1
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A case of uncommon paratesticular mesothelioma in a young patient is presented. Its questionable malignancy, as well as the method of treatment are discussed.

In plain English

This case report from Rambam Medical Center, Haifa, Israel, described a 20-year-old soldier with 3 weeks of pain and swelling in the left testicle. Scans showed no enlarged lymph nodes or mass, and blood tumor markers were normal. During surgery through the groin, several lesions of 0.5 to 2 cm were found along the spermatic cord. A frozen section taken during the operation was not conclusive, so the testis was left in place. The final pathology report showed a paratesticular papillary mesothelioma without gross atypia (marked cell abnormality), and no mitoses (dividing cells) were seen. The article was inconsistent about the pathologists' 'potentially malignant' label. The case report linked it to tumors larger than 2 cm, while the discussion said it rested on the lesions being less than 2 cm. The patient then had the testis removed (radical orchiectomy), refused further treatment, and was lost to follow-up. The report gives no asbestos exposure history for this patient. The discussion notes that the cause is unknown and that other reports have linked such tumors to asbestos. The authors concluded that the malignant potential and management of this tumor remain controversial.

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 (single patient)
• Who was studied: One 20-year-old male soldier treated at Rambam Medical Center, Haifa, Israel, with pain and swelling in the left testicle that began 3 weeks before admission
• Exposure: The article does not report any asbestos or other exposure for this patient. The discussion only notes that other reports have associated these tumors with asbestos exposure, prior scrotal procedures or chronic irritation.
• Main results:
  • Before surgery, imaging (excretory urogram and pelvic and abdominal CT scans) showed no lymphadenopathy or mass.
  • Serum alpha-fetoprotein and human beta-chorionic gonadotropin were normal.
  • At operation, several small lesions measuring 0.5 to 2 cm were found along the spermatic cord. A frozen section was not conclusive, and the testis was put back in place.
  • The final pathology report showed a paratesticular papillary mesothelioma without gross atypia. The figure caption notes no mitotic activity.
  • In the case report, the pathologists' definition of the lesion as potentially malignant is tied to tumors larger than 2 cm.
  • In the discussion, the same 'potentially malignant' description is said to rest on the lesions being less than 2 cm in size, which contradicts the case report section.
  • The patient was re-operated and had a radical orchiectomy. He refused any other treatment and was lost to follow-up, so his outcome is not reported.
• The authors' conclusion: The authors concluded that the malignant potential of paratesticular mesothelioma is controversial and that its management remains questionable, with its natural history uncertain. They stated there is still debate over whether laparotomy and lymphadenectomy should be done or the patient followed with periodic CT scans.

Topics

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

Medical terms in this study, explained in our Lexicon: Paratesticular, Well-Differentiated Papillary Mesothelioma, Testicular Mesothelioma.

Related studies

• Immunohistochemical profile of paratesticular serous papillary adenocarcinoma and tunica vaginalis facilitates distinction from malignant mesothelioma — P.R. Anchala, R. Dhir, et al. (2011)
• Well-differentiated papillary mesothelioma: a clinicopathological and immunohistochemical study of 18 cases with additional observation — X. Chen, W. Sheng, et al. (2013)
• Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis: Case Report and Systematic Review of Literature — W.K. Tan, M.Y. Tan, et al. (2016)
• Well-differentiated papillary mesothelioma of tunica vaginalis testis of unknown malignant potential: Sonographic appearance — K.W.S. Ko, K.S. Tse, et al. (2018)
• Adult paratesticular tumours — B. Khoubehi, V. Mishra, et al. (2002)
• Paratesticular mesothelioma. Report of a case with comprehensive review of literature — M. Bisceglia, D.B. Dor, et al. (2010)

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