Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: analysis of published case-series data

Abstract

Purpose Mesothelioma of the tunica vaginalis testis (MTVT) is a rare tumor, and currently, there are no published treatment recommendations. Methods We performed a systematic literature review and synthesized clinical presentation, clinicopathological factors associated with metastatic disease, treatment options, and outcomes in men with MTVT. Results We included 170 publications providing data on 275 patients. Metastatic disease occurred in 84/275 (31%) men with malignant MTVT: Most common sites included retroperitoneal lymph nodes (LNs) (40/84, 48%), lungs (30/84, 36%), and inguinal LNs (23/84, 27%). Invasion of the spermatic cord or scrotum was the only risk factor for local recurrence [odds ratio (OR) 3.21, 95% confidence interval (CI) 1.36–7.57]. Metastatic disease was associated with age ≥ 42 years (OR 3.02, 95% CI 1.33–6.86), tumor size ≥ 49 mm (OR 6.17, 95% CI 1.84–20.74), presence of necrosis (OR 8.31, 95% CI 1.58–43.62), high mitotic index (OR 13.36, 95% CI 1.53–116.51) or angiolymphatic invasion (OR 3.75, 95% CI 1.02–13.80), and local recurrence (OR 4.35, 95% CI 2.00–9.44). Complete remission in the metastatic setting was observed in five patients, most of whom were treated with multimodal therapy. Median survival in patients with metastatic disease was 18 months (IQR 7–43). Conclusion Malignant MTVT is a rare but aggressive disease. Since local recurrence is a risk factor for metastatic progression, we recommend aggressive local treatment. Survival and response to any treatment in the metastatic setting are limited.

Malignant Mesothelioma of Tunica Vaginalis Testis: Update for 2022

“…3 Predictive factors for metastasis were age 42 years and older, size > 49 mm, necrosis, high mitotic index, and angiolymphatic invasion. 3…”

“…Most reported patients are over age 50, with median ages at diagnosis reported as 61, 62, or 72. 3,9,10 The well-differentiated papillary type, in contrast, has occurred mostly in younger men 11,12 with the exception of one 70-year-old. 13 The oldest patient reported was age 90.…”

“…Inguinal lymph nodes are the first to be involved by metastasis 9. Metastasis is found synchronously or metachronously at a rate of 31%,3 with lymph nodes being the most common site, followed by lungs. A much less frequent site of metastasis is the liver, being reported in at least 3 cases 1,2,22…”

“…In the largest meta-analysis, the only significant histopathologic risk factor for local recurrence (in the largest meta-analysis) was the invasion of the spermatic cord or scrotum and local recurrence predicted metastasis (odds ratio: 4.35) 3. Predictive factors for metastasis were age 42 years and older, size >49 mm, necrosis, high mitotic index, and angiolymphatic invasion 3…”

“…1 The number of reported cases was 80 in the year 2002 2 ; 20 years later, however, 275 total patients have been reported among 170 publications. [3][4][5][6][7][8] About 4% of cases are bilateral. 1…”