Malignant mesothelioma of tunica vaginalis: Two extremely rare case reports

Abstract

Introduction: Malignant mesothelioma (MM) of tunica vaginalis is a very rare tumor and it has a poor prognosis. It is not easy to diagnose the disease preoperatively because there is a lack of comprehensive studies and information about the disease. We would like to present our two cases with severe scrotal edema and hydrocele, which were debrided perioperatively due to scrotal necrosis, followed by radical inguinal orchiectomy and subsequently diagnosed as MM of tunica vaginalis. Case 1: A 74-year-old male patient with bilateral scrotal swelling for 6 months. Right radical inguinal orchiectomy was performed. The pathology result of right radical inguinal orchiectomy material was compatible with malignant mesothelioma of tunica vaginalis. Case 2: A 90-year-old male patient with complaints of right scrotal swelling for 3 years. A right radical inguinal orchiectomy was performed. The pathology result of right radical inguinal orchiectomy material was compatible with malignant mesothelioma of tunica vaginalis. Conclusion and discussion: MM has a very poor prognosis therefore early treatment plan should be made. Surgery is the main treatment for malignant mesothelioma of the testis. Although chemotherapy and radiotherapy play an active role in the treatment of metastatic disease, surgery is the first-line therapy in the treatment of the tumor. Also; long-term hydrocele, recurrent epididymitis, scrotal edema can make it harder to detect the tumor diagnosis. MM should be considered in such patients. Necrosis and abscess appearance was not mentioned before in published case reports. In this respect, it should not be ignored the long-term hydrocele situation and the appearance of abscess-epididymitis that cannot be treated properly.

Patient with recurrent paratesticular malignant mesothelioma and multiple primary neoplasms

“…The accurate diagnosis of MM of the spermatic cord is crucial but rarely achieved preoperatively, posing a challenge for patient management [12,13]. Most cases of MM of the spermatic cord are determined intraoperatively and present with papillary excrescences or fibrotic thickening of tunica vaginalis with or without hemorrhagic hydrocele fluid [8].…”

A rare malignant mesothelioma of the tunica vaginalis testis: A case report

“…Spiess et al ( 15 ) reported that 4 of 5 patients with mesothelioma had a history of asbestos exposure. A 10-fold increase in the risk of malignant mesothelioma has been reported among the immediate family members of patients with a history of asbestos exposure ( 16 ). In addition, conditions such as an old testicular injury, hiatal hernia and long-term syringomyelia may also be predisposing factors for the development of this disease ( 1 , 17 , 18 ).…”

Malignant Mesothelioma of Tunica Vaginalis Testis: Update for 2022

“…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 men11,12 with the exception of one 70-year-old 13. The oldest patient reported was age 90 14.…”

“…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. 14 The best-established risk factor for tunica vaginalis mesothelioma is asbestos exposure, present in 34% of the patients whose history was reported.…”