Preoperative cytological diagnosis of malignant mesothelioma of tunica vaginalis

Our plain-English summary of Preoperative cytological diagnosis of malignant mesothelioma of tunica vaginalis, by A. Bandyopadhyay, S. Bhattacharya, K. Konar (Diagnostic Cytopathology, 2015).

The study

• Authors: A. Bandyopadhyay, S. Bhattacharya, K. Konar
• Journal: Diagnostic Cytopathology
• Published: 2015;43(10):850-4
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma of tunica vaginalis testis is a rare aggressive neoplasm with ∼200 cases reported so far. A correct preoperative diagnosis of this rare tumor is difficult. Fine-needle aspiration cytology (FNAC) is a rapid and inexpensive diagnostic tool that may prove helpful in such cases. Very few cases have been diagnosed on cytology so far, and the descriptions of the cytological features have rarely been described in the literature. In this report we present the cytological features of malignant mesothelioma of tunica vaginalis testis which was diagnosed by FNAC and subsequently confirmed by histopatholoy and immunohistochemical (IHC) studies.

© 2015 Wiley Periodicals, Inc.

In plain English

This case report, by pathologists at Burdwan Medical College in India, described one man, a 40-year-old farmer with a painless, large scrotal swelling of about nine months' duration. Ultrasound showed a lesion made of multiple nodules in the right testicular region. A sample of cells drawn through a thin needle (fine-needle aspiration cytology) led the authors to suggest a presumptive diagnosis of malignant mesothelioma possibly arising from the tunica vaginalis, the membrane around the testis. On further questioning, the man reported no personal history of direct asbestos exposure. Blood levels of two testicular tumor markers were normal, and lactate dehydrogenase was mildly raised. The testis was surgically removed. Tissue examination found a papillary epithelial mesothelioma that had invaded the testis and the epididymis. The tumor stained positive for several mesothelioma markers and negative for WT1 and for markers associated with adenocarcinoma. The patient was lost to follow-up. The authors concluded that, though challenging, detailed radiological and cytological examination may prove sufficient for preoperative diagnosis of this rare tumor.

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 40-year-old man, a farmer, with a painless large scrotal swelling of about 9 months' duration, seen in the surgery outpatient department. The authors are from the Department of Pathology, Burdwan Medical College, Burdwan, India. No dates of care are given.
• Exposure: No asbestos exposure was identified: on questioning, the patient reported no personal history of direct asbestos exposure. His occupation was farmer. No fiber type was involved.
• Main results:
  • Ultrasound showed a lesion in the right testicular region made of multiple nodules, the largest measuring 2.5 by 2.5 cm. The right testis was not visualized and the left testis appeared normal.
  • Fine-needle aspiration cytology showed tumor cells in small papillary clusters and dispersed, with moderately pleomorphic nuclei, many bi- and multinucleated cells, and atypical mitotic figures. On this basis a presumptive diagnosis of malignant mesothelioma possibly arising from the tunica vaginalis was suggested.
  • Cell clusters showed "windows", which the authors said helped them identify the cells as mesothelial.
  • Serum beta-HCG (0.32 mIU/L) and AFP (1.3 ng/mL) were within normal limits. Serum lactate dehydrogenase was mildly raised at 523 U/L (reference value below 480 U/L). The patient was anemic (hemoglobin 10.4 g/dL).
  • After high inguinal orchidectomy, the specimen showed a multinodular mass with hemorrhage and necrosis and a thickened tunica vaginalis. The tumor invaded the testicular parenchyma and involved the epididymis.
  • On immunohistochemistry, the tumor cells were positive for vimentin, pan keratin, calretinin, CK5 and D2-40. They were negative for WT1 and for the adenocarcinoma-associated markers CEA, Ber-EP4 and claudin 4.
  • On histopathology the tumor was diagnosed as papillary-type epithelial mesothelioma of the tunica vaginalis.
  • The authors stated this was the first case of mesothelioma of the tunica vaginalis in which claudin 4 immunostaining was applied.
• The authors' conclusion: The authors concluded that mesothelioma of the tunica vaginalis is an aggressive tumor and that, though challenging, detailed radiological and cytological examination may prove sufficient for preoperative diagnosis.
• Limitations the authors state:
  • The patient was lost to follow-up after an uneventful postoperative period, so no outcome is reported.
  • Most of the immunohistochemical markers used have been studied mainly in pleural and peritoneal mesotheliomas, not in tunica vaginalis tumors, because of the latter's rarity.

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, Neoplasm, Fine-Needle Aspiration, Cytology.

Related studies

• Mesothelioma of the tunica vaginalis: a series of eight cases with uncertain malignant potential — F. Brimo, P.B. Illei, et al. (2010)
• Mesothelioma of the tunica vaginalis testis — K.J. Butnor, E.N. Pavlisko, et al. (2019)
• 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)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Preoperative diagnosis of malignant mesothelioma of the tunica vaginalis using Doppler ultrasound — P. Aggarwal, A. Sidana, et al. (2010)

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