Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis: Case Report and Systematic Review of Literature

Our plain-English summary of Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis: Case Report and Systematic Review of Literature, by W.K. Tan, M.Y. Tan, W.S. Tan, et al (Clinical Genitourinary Cancer, 2016).

The study

• Authors: W.K. Tan, M.Y. Tan, W.S. Tan, S.C. Gan, R. Pathmanathan, H.M. Tan, W.P. Tan
• Journal: Clinical Genitourinary Cancer
• Published: 2016;14(4):e435-9
• Type of article: Case report, Systematic review
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors reported a case of well-differentiated papillary mesothelioma (WDPM) of the tunica vaginalis and reviewed the published cases. A 39-year-old Chinese man with no previous asbestos exposure had a 2-month history of painless right scrotal swelling. Ultrasonography showed a large right hydrocele and a 2.79 cm × 1.95 cm × 2.49 cm polypoidal mass. Computed tomography showed no metastatic disease. The lesion, on the epididymal head, was removed by wide local excision. It measured 4 cm × 3 cm × 1.5 cm and showed tubular-papillary architecture, a single row of cuboidal mesothelial cells, bland nuclei, inconspicuous mitoses and no stromal invasion. Two authors searched PubMed, MEDLINE, Embase and Cochrane through December 31, 2015, for English-language case reports and series. They found 24 cases of paratesticular WDPM. Sixteen were excluded because of complex morphology or malignancy, leaving 8 'true' WDPM cases. Patients were aged 18 to 70 years (mean 48). Seven presented as a hydrocele and 1 as a scrotal mass. Five cases reported no asbestos exposure, and in 3 the asbestos history could not be obtained. The patient reported 15 years of Plaster of Paris exposure. No reported case had relapsed or metastasized. The authors concluded that asbestos exposure may not be, or may be only a minor, risk factor for WDPM. They proposed frozen section (cryosection) with wide local excision rather than radical orchiectomy, especially in younger patients, when a negative margin is achievable.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article combined a case report with a systematic review of published cases of well-differentiated papillary mesothelioma (WDPM) of the tunica vaginalis, the lining around the testis. As the authors describe, WDPM is considered benign, unlike malignant mesothelioma. Their patient was a 39-year-old Chinese man with a painless right scrotal swelling, no asbestos exposure, and 15 years of Plaster of Paris exposure. The tumor was removed with a wide margin, sparing the testis. Searching four databases through December 31, 2015, the authors found 24 cases and judged only 8 (including theirs) to be 'true' WDPM. Ages ranged 18 to 70 (mean 48); 7 of the 8 presented as a hydrocele. Five of the 8 reported no asbestos exposure; the other 3 lacked detailed exposure histories. No reported case had relapsed. The authors suggested asbestos may not be, or may only be a minor, risk factor for WDPM, though a contributing role remains plausible. They favored wide local excision over removing the testis, especially in younger patients, if clear margins were achievable, but advised removal when the tumor involves the testis.

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 combined with a systematic review of published case reports and case series
• Who was studied: One 39-year-old Chinese man with a right scrotal swelling, plus 24 published paratesticular WDPM cases found in PubMed, MEDLINE, Embase and Cochrane through December 31, 2015 (English-language only). Of these, 8 (including the authors' case) were judged 'true' WDPM.
• Exposure: Asbestos exposure history as reported in each case. The authors' patient had no asbestos exposure but reported a 15-year history of Plaster of Paris (calcium sulfate) exposure and long-term use of cleaning detergents.
• Main results:
  • The patient's tumor was on the head of the epididymis and was completely removed with a wide margin. Tissue examination confirmed WDPM. Follow-up was 6 months to date.
  • Of 24 identified cases, 16 were excluded as mesothelioma of uncertain malignant potential or as malignant mesothelioma, leaving 8 'true' WDPM.
  • Among the 8 'true' WDPM cases, ages ranged from 18 to 70 years, with a mean of 48 years.
  • Of the 8 'true' WDPM cases, 7 presented as a hydrocele and 1 as a scrotal mass.
  • Among the 8 'true' WDPM cases, 5 reported no asbestos exposure. For the other 3, a detailed asbestos exposure history could not be obtained.
  • The authors interpreted this as suggesting that asbestos may not be, or may only be a minor, risk factor for WDPM, and that other environmental factors may play a bigger role.
  • The authors still considered a contributing role for asbestos plausible.
  • None of the WDPM cases reported in the literature had shown a relapse.
  • The authors advised radical orchiectomy (removal of the testis) where the tumor involves the testicle.
• The authors' conclusion: The authors proposed cryosection with wide local excision as the treatment of choice rather than radical orchiectomy, especially among younger patients, if a negative margin is achievable.

Topics

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

Medical terms in this study, explained in our Lexicon: Well-Differentiated Papillary Mesothelioma, Tunica Vaginalis, Systematic Review, Asbestos Exposure, Hydrocele, Mesothelial Cells, Paratesticular, Frozen Section.

Related studies

• Well-differentiated Papillary Mesothelioma of the Tunica Vaginalis — W.K. Tan, M.Y. Tan, et al. (2016)
• Case Report of a Well-Differentiated Papillary Mesothelioma of the Tunica Vaginalis in an Undescended Testis With Review of Literature — P. Parcesepe, S. Sina, 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)
• Well differentiated (benign) papillary mesothelioma of the tunica vaginalis — R. Chetty (1992)
• 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)
• Well-differentiated papillary mesothelioma of the tunica vaginalis: a case study and review of the literature — S. Erdogan, A. Acikalin, et al. (2014)

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