Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature

Abstract

Background: Malignant mesothelioma of the tunica vaginalis is a rare tumour which comprises less than 1% of all mesotheliomas. Case presentation: 69-years old patient with painful hard mass and hydrocele in the right scrotum to whom a right hydrocelectomy was performed. Any history of scrotal trauma or exposure to asbestos was not present. Excisional biopsy revealed a multinodular tumour with focal areas of necrosis and infiltrative growth. According to morphological and immunohistochemical findings, diagnosis of malignant biphasic mesothelioma of the tunica vaginalis testis was made. Two months after hydrocelectomy, right inguinal orchidectomy was performed. Postsurgical whole body CT scan revealed paraaortic and pararenal lymphadenopathy, likely to be metastatic. Adjuvant treatment with 6 cycles of cisplatin and pemetrexed was applied. After 3 cycles of chemotherapy, CT scan showed progression and the treatment was changed to gemcitabine 1 month after. Conclusions: Although malignant mesothelioma of the tunica vaginalis is a rare malignancy, it poses a diagnostic challenge which can mimic common inguinal or scrotal diseases such as hydrocele. Despite aggressive surgical procedures or adjuvant therapies, the prognosis remains poor.

Malignant Mesothelioma of Tunica Vaginalis Testis: Update for 2022

“…16 Longstanding hydrocele is implicated in many cases. 15,[17][18][19] Other presentations included recurrent epididymitis 19 or a pyocele. 20 Ultrasonography of the scrotum is expected to show the thickened wall of a hydrocele, and a hypoechoic nodule involving the tunica vaginalis and sometimes extending into epididymis.…”

“…In 1 patient who had a history of asbestos exposure, concomitant involvement of the pleura and peritoneum were present, with the chronologic clinical sequence suggesting the pleura as the initially involved site 16. Long-standing hydrocele is implicated in many cases 15,17–19. Other presentations included recurrent epididymitis19 or a pyocele 20…”

Testicular Germ Cell Tumors: Serological and Immunohistochemical Diagnosis

“…These tumors are mentioned only for the completeness of the presentation and will not be discussed in detail. Tumors originating from testicular adnexa, including rete testis, or tunica vaginalis (mesothelial cells) and some embryonic structures that normally involute during fetal life, such a műllerian ducts, are also quite rare (16)(17)(18)(19)(20). Metastatic tumors to the testis and lymphoma are rare but must be considered in the differential diagnosis, especially in elderly patients (21,22).…”

High Expression of SMO and GLI1 Genes with Poor Prognosis in Malignant Mesothelioma

“…Mesothelioma occurs mainly in the pleura, accounting for more than 85% of cases, and peritoneal mesothelioma accounts for 10%. Most malignant mesotheliomas are associated with exposure to asbestos [3][4][5]. By and large, tumors begin as multiple small plasma membrane nodules, which then fuse with each other, leading to the fusion of the visceral and mural plasma membranes with each other and encapsulating the tumor site.…”