Testicular mesothelioma disguised as hydrocele: a case report

Our plain-English summary of Testicular mesothelioma disguised as hydrocele: a case report, by T. Nazar, A. Gopalakrishnabhaktan, F.A.A. Tashrifwala, et al (Journal of Medical Case Reports, 2024).

The study

• Authors: T. Nazar, A. Gopalakrishnabhaktan, F.A.A. Tashrifwala, A. Sathish, T. Dave
• Journal: Journal of Medical Case Reports
• Published: 2024;18(1):114
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Testicular tumors have many different manifestations. The majority of these cases are presented as an incidental finding during hydrocelectomy. Malignant mesotheliomas are uncommon tumours that can arise from the coelomic epithelium of the pleura, peritoneum, pericardium, and tunica vaginalis.

Case Presentation: We present a 51-year-old South Asian (Indian) male patient with a rare case of mesothelioma, presenting with right hydrocele, to whom a right hydrocelectomy was performed. Any history of trauma or asbestos exposure was not present. Histopathological and immunohistochemistry reports revealed a malignant mesothelioma of tunica vaginalis. There was no invasion of the tumour to the epididymis and spermatic cord. Imaging studies showed no signs of metastasis. 1 month later, a high inguinal orchidectomy was performed. The patient underwent adjuvant chemotherapy thereafter and is still on follow-up.

Conclusion: Although hydrocele is common, detailed evaluation is mandatory to rule out certain rare tumours-testicular and paratesticular variants.

© 2024. The Author(s).

In plain English

This case report described one patient, a 51-year-old South Asian (Indian) man with a right-sided scrotal swelling of one year that had grown over 6 to 7 months. The article states he had no history of trauma or asbestos exposure. Tests suggested a hydrocele (a fluid collection in the scrotum), and the tumour markers LDH, AFP and beta-HCG were normal. During surgery for the hydrocele, a growth was found attached to the tunica vaginalis, the lining around the testis. It was diagnosed as a poorly differentiated malignant mesothelioma of the right tunica vaginalis, and a high inguinal orchidectomy (removal of the testis through the groin) followed. Lymphovascular invasion was present, but the epididymis, testis and spermatic cord were free of tumour. A PET CT suggested possible residual disease. After 6 cycles of pemetrexed and carboplatin, imaging showed a complete response, and follow-up visits showed no signs of tumour growth. The authors concluded that this rare cancer should be kept in mind for any testicular mass, even without exposure to a risk factor.

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 51-year-old South Asian (Indian) man with right scrotal swelling of 1 year duration, treated at VPS Lakeshore Hospital & Research Centre, Kochi, Kerala, India; dates of care not stated
• Exposure: No asbestos exposure reported; the article states the patient had no history of trauma or asbestos exposure
• Main results:
  • Before surgery, the findings suggested a hydrocele, and the patient's LDH, AFP and beta-HCG levels were normal
  • During the hydrocelectomy, a growth attached to the tunica vaginalis was found and removed with the hydrocele sac
  • Pathology showed malignant mesothelioma of the right tunica vaginalis, poorly differentiated variant; tumour cells stained positive for CK, CK7, Calretinin and WT1, and negative for CK20, Inhibin, CD30 and Glypican 3
  • Lymphovascular invasion was present, but the epididymis, testes and spermatic cord showed no tumour
  • A PET CT done to rule out distant spread suggested possible residual disease
  • After 6 cycles of pemetrexed and carboplatin given once every 3 weeks, reassessment imaging showed a complete treatment response
  • Follow-up visits showed no clinical or radiological signs of tumour growth (length of follow-up not stated)
• The authors' conclusion: The authors concluded that a hydrocele should be closely monitored, and that testicular mesothelioma, though extremely rare, should be considered in patients with a testicular mass even if they have no history of exposure to a risk factor

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, Hydrocelectomy, Malignant Mesothelioma, Epithelium, Pleura, Peritoneum, Pericardium.

Related studies

• Paratesticular malignant mesothelioma associated with abdominoscrotal hydrocele — A.L. Velasco, J. Ophoven, et al. (1988)
• Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology — S.C. Gupta, A.K. Gupta, et al. (1998)
• Multiple mesotheliomas of the hydrocele sac: a case report — C.L. Reynolds (1958)
• Malignant mesothelioma of testicular tunica vaginalis — K. Abe, N. Kato, et al. (2002)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)

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