Malignant Mesothelioma of the Tunica Vaginalis Testis

Abstract

A patient is described with an indolent scrotal mass complicated by acute hydrocoele which was proven to be due to malignant mesothelioma of the tunica vaginalis testis. Although uncommon, the possibility of scrotal mass lesion should be considered in ultrasound examination of hydrocoeles with atypical presentations.

Malignant mesothelioma of the tunica vaginalis testis: atypical sonographic appearance.

“…1,3 Less frequently, the presence of a paratesticular or testicular mass, as in our patient, may be the apparent symptom. 1,4 In patients with hydrocele, results of fluid cytologic analysis are frequently negative. The rapid reaccumulation of fluid, however, raises the suggestion of malignancy.…”

“…3 Malignant mesothelioma of the tunica vaginalis has a variety of sonographic appearances. 1,4,[6][7][8] Commonly a hydrocele, either simple or complex (low-level echoes), is present. The hydrocele can be associated with (1) multiple extratesticular soft tissue fronds of mixed echogenicity (a hypoechoic center surrounded by a hyperechoic rim) seen extending into it; (2) multiple heterogeneous extratesticular nodular masses, ranging from a few millimeters to several centimeters in size, attached to the tunica vaginalis; or (3) a single heterogeneous extratesticular mass arising in the scrotal wall.…”

Well‐differentiated papillary mesothelioma of tunica vaginalis testis of unknown malignant potential: Sonographic appearance

“…Sonographic appearance of MM has been documented in several reports in the literature . It commonly involves a hydrocele, which may be anechoic or may contain low‐level echoes.…”

“…6 Sonographic appearance of MM has been documented in several reports in the literature. [11][12][13][14] It commonly involves a hydrocele, which may be anechoic or may contain low-level echoes. This hydrocele is usually associated with multiple paratesticular papillary masses with complex frondlike structure, showing heterogeneous echotexture with hypoechoic core and hyperechoic periphery.…”

Malignant Mesothelioma of the Tunica Vaginalis Testis

“…2 Variable sonographic appearances of malignant mesothelioma contribute to the difficulty in making a diagnosis with imaging. Typically, a simple or complex (low-level echoes) hydrocele is present, which can be associated with the following: (1) multiple extratesticular nodular masses of variable echogenicity, ranging from a few millimeters to several centimeters in size 2,19-21 ; (2) a single hypoechoic mass located in the epididymal head, 22,23 in the parietal tunica layer inside the hydrocele space, 24 within the scrotal sac, 25,26 or intratesticularly 27 ; (3) multiple extratesticular papillary projections of mixed echogenicity 5,28 ; (4) focal irregular thickening of the tunica vaginalis 2,29,30 ; and (5) a simple hydrocele as the only sonographic finding. 1,31,32 Imaging characteristics on color Doppler sonography for evaluating malignant mesothelioma of the tunica vaginalis have recently been described.…”