Preoperative diagnosis of malignant mesothelioma of the tunica vaginalis using Doppler ultrasound

Our plain-English summary of Preoperative diagnosis of malignant mesothelioma of the tunica vaginalis using Doppler ultrasound, by P. Aggarwal, A. Sidana, S. Mustafa, et al (Urology, 2010).

The study

• Authors: P. Aggarwal, A. Sidana, S. Mustafa, R. Rodriguez
• Journal: Urology
• Published: 2010;75(2):251-2
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Malignant mesothelioma (MM) of the tunica vaginalis is a rare aggressive tumor with a high predilection for metastatic spread. Because there is no preoperative diagnostic modality available, it has high recurrence and mortality rates, which emphasizes the importance of early preoperative diagnosis for proper and adequate treatment. We describe a case of MM of the tunica vaginalis in a 73-year-old man who presented with hydrocele and was preoperatively diagnosed with MM using Doppler in addition to scrotal ultrasound. He underwent early radical orchiectomy through an inguinal approach, resulting in improved survival.

2010 Elsevier Inc. All rights reserved.

In plain English

This was a short case report, published as an "Images in Clinical Urology" item, about one man with malignant mesothelioma of the tunica vaginalis, the lining around the testis. The article does not mention asbestos or any other exposure. The man, described as 75 years old in the article text, had a painless swelling of the left scrotum for a year. Examination found a tense fluid collection (hydrocele). Ultrasound showed small masses growing from the tunica vaginalis on a central blood-vessel stalk, and Doppler ultrasound showed increased signal in that stalk. Mesothelioma was suspected before surgery, and he had a radical orchiectomy (removal of the testis). Pathology findings were consistent with mesothelioma. He stayed free of recurrence until 30 months, when lymph nodes in the back of the abdomen were found to contain cancer. Two years later there were tumor deposits in the skin, and later in the lungs and liver. He died 76 months after surgery. The authors believed earlier treatment may be partly responsible for his longer survival, compared with a median of 23 months reported in an earlier published review. They concluded that Doppler with ultrasound is one of the safest and reliable methods for diagnosing this tumor before surgery.

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; 'Images in Clinical Urology' item)
• Who was studied: One man, aged 75 according to the article text, with a painless left scrotal enlargement for a year; treated at the Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
• Exposure: Not reported; the article does not mention asbestos or any other exposure
• Main results:
  • On examination, the patient had a tense hydrocele that let light through (transilluminating), and the testis could not be felt
  • Scrotal ultrasound showed small masses arising from the tunica vaginalis with a central vascular stalk
  • Doppler ultrasound showed increased signal in the stalk
  • Based on examination, sonogram and Doppler, malignant mesothelioma was suspected before surgery, and the patient underwent radical orchiectomy
  • Pathology findings were consistent with malignant mesothelioma
  • The patient remained recurrence-free until 30 months, when CT showed enlarged para-aortic lymph nodes
  • Retroperitoneal lymph node dissection showed metastatic disease. Two years later he had tumor deposits in the skin and enlarged abdominal nodes
  • Later scans showed metastatic disease in the lungs and liver
  • The patient died in hospice 76 months after surgery
  • The authors cited a median survival of 23 months for this tumor from an earlier published review (Plas et al.); this figure is not a finding of this case report
  • The authors believed that definitive treatment offered earlier in this case may be partly responsible for the prolonged survival
• The authors' conclusion: The authors concluded that Doppler study with ultrasound is one of the safest and reliable methods for diagnosing malignant mesothelioma of the tunica vaginalis before surgery

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, Doppler Ultrasound, Hydrocele, Ultrasound, Orchiectomy.

Related studies

• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Preoperative cytological diagnosis of malignant mesothelioma of tunica vaginalis — A. Bandyopadhyay, S. Bhattacharya, et al. (2015)
• Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis — S.S. Chekol, C.C. Sun (2012)
• Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology — S.C. Gupta, A.K. Gupta, et al. (1998)
• Preoperative Circulating Tumor DNA in Patients with Peritoneal Carcinomatosis is an Independent Predictor of Progression-Free Survival — J.M. Baumgartner, V.M. Raymond, et al. (2018)
• Preoperative computed tomography does not predict resectability in peritoneal carcinomatosis — J.D. Rivard, W.J. Temple, et al. (2014)

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