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Radovanovic M, Kojic U, Zubelic A, Jakulic D, Filipovic Z. Timely Surgical Resection Achieved Prolonged Remission in Patients With Malignant Mesothelioma of the Tunica Vaginalis Testis and Retroperitoneal Recurrence. Cureus 2024; 16:e59052. [PMID: 38800313 PMCID: PMC11128090 DOI: 10.7759/cureus.59052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare tumor of the testicular sheath. More than 50% of cases initially present as recurrent hydrocele, but there have also been documented cases with hematocele, inguinal hernia, or epididymitis. Due to the non-specific symptoms and signs of the disease, it is almost always diagnosed intra- or postoperatively. The lack of standardized therapy protocols, as well as the lack of evidence supporting systemic chemotherapy, have fueled arguments in favor of the necessity of retroperitoneal lymph node dissection (RPLND) in the treatment of the disease, especially in the case of lymph node metastasis. We present a case of MMTVT achieving prolonged remission after timely and extensive surgical treatment.
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Affiliation(s)
- Milan Radovanovic
- Clinic of Urology, University Clinical Centre of Serbia, Clinic of Urology, Belgrade, SRB
| | - Uros Kojic
- Urology, University Hospital Medical Center Bezanijska Kosa, Belgrade, SRB
| | | | - Djordje Jakulic
- Urology, University Hospital Medical Center Bezanijska Kosa, Belgrade, SRB
| | - Zoran Filipovic
- Urology, University Hospital Medical Center Bezanijska Kosa, Belgrade, SRB
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Kalantari F, Schweighofer-Zwink G, Rendl G, Pirich C, Beheshti M. 18F-FDG and 68Ga-PSMA PET/CT in Paratesticular Mesothelioma. Clin Nucl Med 2024; 49:332. [PMID: 38427957 DOI: 10.1097/rlu.0000000000005123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
ABSTRACT A 66-year-old man with local prostate adenocarcinoma underwent radical prostatectomy (Gleason score 3 + 4 = 7, pT2c) in 2016. Four years later, he presented with a hydrocele and cystic atypical change in the left scrotum and soft tissue in the left groin. Final histopathology revealed spermatic cord mesothelioma and left hemangiosis carcinomatosa. A bone biopsy of the sacrum revealed infiltrates of a prostatic adenocarcinoma with small cell neuroendocrine differentiation. Dual-tracer PET/CT imaging using 18F-FDG and 68Ga-PSMA was able to identify local recurrence of scrotal mesothelioma and differentiate metastases of prostate cancer from malignant mesothelioma.
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Affiliation(s)
- Forough Kalantari
- From the Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, Salzburg, Austria
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Nazar T, Gopalakrishnabhaktan A, Tashrifwala FAA, Sathish A, Dave T. Testicular mesothelioma disguised as hydrocele: a case report. J Med Case Rep 2024; 18:114. [PMID: 38409016 PMCID: PMC10898004 DOI: 10.1186/s13256-024-04348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/29/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Testicular tumors have many different manifestations. The majority of these cases are presented as an incidental finding during hydrocelectomy. Malignant mesotheliomas are uncommon tumours that can arise from the coelomic epithelium of the pleura, peritoneum, pericardium, and tunica vaginalis. CASE PRESENTATION We present a 51-year-old South Asian (Indian) male patient with a rare case of mesothelioma, presenting with right hydrocele, to whom a right hydrocelectomy was performed. Any history of trauma or asbestos exposure was not present. Histopathological and immunohistochemistry reports revealed a malignant mesothelioma of tunica vaginalis. There was no invasion of the tumour to the epididymis and spermatic cord. Imaging studies showed no signs of metastasis. 1 month later, a high inguinal orchidectomy was performed. The patient underwent adjuvant chemotherapy thereafter and is still on follow-up. CONCLUSION Although hydrocele is common, detailed evaluation is mandatory to rule out certain rare tumours-testicular and paratesticular variants.
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Affiliation(s)
- Tanya Nazar
- VPS Lakeshore Hospital & Research Centre, Kochi, Kerala, India
| | | | | | - Aroma Sathish
- VPS Lakeshore Hospital & Research Centre, Kochi, Kerala, India
| | - Tirth Dave
- Bukovinian State Medical University, Chernivtsi, Ukraine.
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Behers BM, Guske CW, Behers BJ, Kortum SB, Bermingham IG, Warner CL, Carey RI. Malignant Epithelioid Mesothelioma of the Tunica Vaginalis Testis Presenting as Hydrocele in a Kidney Transplant Recipient. Case Rep Urol 2024; 2024:9227764. [PMID: 38239857 PMCID: PMC10794071 DOI: 10.1155/2024/9227764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 12/07/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Abstract
Mesotheliomas of the tunica vaginalis testis are rare malignant tumors that can present as a scrotal mass or hydrocele. These tumors are typically aggressive with high rates of recurrence and metastasis. Suspected risk factors for malignant mesothelioma include asbestos exposure, chronic inflammation, trauma, and persistent hydrocele. We report the case of a malignant epithelioid mesothelioma of the tunica vaginalis testis that presented as a finding at hydrocelectomy and was ultimately treated with radical inguinal orchiectomy. This patient was on chronic immunosuppression therapy with tacrolimus and mycophenolate mofetil secondary to a kidney transplant but had none of the common risk factors for mesothelioma formation. To our knowledge, this is the first case describing a possible connection between chronic immunosuppression and mesothelioma of the tunica vaginalis. However, future studies are needed to investigate this association and discern whether this could have played a role in our patient or if his mesothelioma formation was coincidental.
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Affiliation(s)
- Brett M. Behers
- University of South Florida College of Medicine, Tampa, FL, USA
| | | | | | | | | | | | - Robert I. Carey
- Jellison Cancer Institute, Sarasota Memorial Hospital, Sarasota, FL, USA
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Chys B, De Graeve N, Merckx L. Well differentiated papillary mesothelioma of the tunica vaginalis: case report. Acta Chir Belg 2023; 123:555-558. [PMID: 35322759 DOI: 10.1080/00015458.2022.2056810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/19/2022] [Indexed: 11/01/2022]
Abstract
Well differentiated papillary mesothelioma (WDPM) is a rare entity making up 0.3-5% of all mesothelioma cases, while manifestations of the tunica vaginalis are even more uncommon. Literature on WDPM is scarce and our understanding is rather limited. Cellular architecture, stromal invasion, mitotic activity and immunohistochemical markers are used to distinguish well differentiated entities from more malignant subspecies. These cases confront both pathologists and clinicians with a hefty diagnostic challenge. Although no paratesticular WDPM specific mortality has been reported, the prognosis of a malignant mesothelioma is very poor. A correct diagnosis is therefore of the utmost importance. In this paper we provide an overview on the diagnosis and differentiation of mesotheliomas of the tunica vaginalis. Furthermore, we highlight pitfalls and build up a recommended therapeutic strategy.
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Affiliation(s)
- Brecht Chys
- Department of Urology, St. Lucas Hospital, Ghent, Belgium
- Department Urology, University Hospitals Leuven, Leuven, Belgium
| | - Nico De Graeve
- Department of Urology, St. Lucas Hospital, Ghent, Belgium
| | - Luc Merckx
- Department of Urology, St. Lucas Hospital, Ghent, Belgium
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Charlaix Hidalgo AL, Roux A, Charissoux A, Mathonnet M, Descazeaud A, Durand Fontanier S, Taibi A. First Case of Abdominal and Tunica Vaginalis Multicystic Benign Mesothelioma: Management and Review of Literature. Indian J Surg Oncol 2023; 14:92-96. [PMID: 37359917 PMCID: PMC10284750 DOI: 10.1007/s13193-022-01693-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Multicystic benign mesothelioma is a rare tumor that affects the serosa. Most cases present with peritoneal lesions exclusively. Some identified risk factors are chronic abdominal inflammation, woman of childbearing age, and asbestos exposure. The symptomatology is not specific and can delay the diagnosis. There are no guidelines for the treatment of this pathology. We describe one male patient with abdominal and tunica vaginalis localizations of multicystic benign mesothelioma. The diagnosis was suspected on imaging and confirmed with histological examination. The treatment on an expert center was complete cytoreduction surgery and HIPEC, but the patient had two recurrences during the 2-year of follow-up. This is the first case of simultaneous rare localizations of multicystic benign mesothelioma. No new risk factors were identified. The case underlines the importance of regular examination of all serosa localizations.
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Affiliation(s)
| | - Alexia Roux
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Aurelie Charissoux
- Pathology Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Muriel Mathonnet
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Aurelien Descazeaud
- Urology Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
| | - Sylvaine Durand Fontanier
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
- University Limoges, CNRS, XLIM, 7252, F-87000 Limoges, UMR France
| | - Abdelkader Taibi
- Digestive Surgery Department, Dupuytren Limoges University Hospital, Limoges, France
- University Limoges, CNRS, XLIM, 7252, F-87000 Limoges, UMR France
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
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Janes WI, Al-Asaaed S, Johnston PH. Malignant Mesothelioma of the Testes with Retroperitoneal Recurrence and Resection in an 80-Year-Old Male and Review of the Literature. Case Rep Oncol 2023; 16:698-704. [PMID: 37933307 PMCID: PMC10625815 DOI: 10.1159/000531839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/29/2023] [Indexed: 11/08/2023] Open
Abstract
Malignant mesothelioma of the testes is an aggressive, yet rare urogenital malignancy, accounting for an infinitesimally small number of oncologic diagnoses. This infrequent occurrence is accompanied by a relative lack of knowledge surrounding this disease, thus limiting management options beyond surgical intervention. Oftentimes, these malignancies present with a poor prognosis despite early intervention and only worsen in the event of metastatic spread with poor survival and limited response to treatment, if any. Our case documents positive patient outcomes following the use of aggressive surgical intervention in the management of a metastatic testicular mesothelioma. A healthy 80-year-old male with sudden painless testicular swelling requiring radical orchidectomy following failed initial conservative management. Pathologically, the specimen was diagnosed as malignant mesothelioma of the right testis with involvement of the tunica albuginea and tunica vaginalis. Following disease recurrence at 82 years of age, the patient subsequently opted for an open right-sided template non-nerve sparing retroperitoneal lymph node dissection which was undertaken without complication. Malignant mesothelioma of the testes remains an ominous diagnosis with historically poor outcomes and for which surgical intervention remains the mainstay of treatment. The retroperitoneal lymphatic drainage represents the most common route of metastatic spread for testicular tumours; however, retroperitoneal lymph node dissection has rarely been employed in this patient population and never in an individual of this age. Our findings contribute to the growing literature surrounding these rare malignancies and outline the importance of considering both patient autonomy and the clinical picture in disease management.
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Affiliation(s)
- W.C. Ian Janes
- Faculty of Medicine, Memorial University, St. John’s, NL, Canada
| | - Sohaib Al-Asaaed
- Faculty of Medicine, Memorial University, St. John’s, NL, Canada
- Division of Oncology, Health Sciences Centre, St. John’s, NL, Canada
| | - Paul H. Johnston
- Division of Urology, Memorial University, St. John’s, NL, Canada
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8
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The Scrotal Excision of Paratesticular Mesothelioma of the Tunica Vaginalis: A Case Report. URO 2022. [DOI: 10.3390/uro2040031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mesotheliomas are malignancies which involve mesothelial cells, and are commonly found in the pleura, peritoneum, pericardium, and (rarely) the testis. We present a case of paratesticular mesothelioma that was excised without the testis. An elderly gentleman presented with a painless right scrotal mass, which appeared clinically benign and separable from the underlying testis. An ultrasound showed an extratesticular lesion adhered to the scrotal wall with a complex hydrocele. An excisional biopsy was conducted, and the Jaboulay procedure was performed on the right testis. Pathological examination revealed mesothelioma, showing focal invasion into the underlying stroma. A post-operative computed tomography (CT) scan evaluation manifested no local or distant metastasis. No further surgery was performed, and no chemotherapy or radiotherapy was offered to the patient. Subsequent clinical examinations and radiological scans carried out during each clinic follow-up for two years showed no new lesion or recurrence.
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de Sá Barrêto Callou Peixoto M, Bernardo Soares MK, Libânio BB, Albuquerque KS, Bacchi CE. Malignant mesothelioma of the tunica vaginalis testis: A rare cause of hydrocele. Urol Case Rep 2022; 43:102048. [PMID: 35287289 PMCID: PMC8917281 DOI: 10.1016/j.eucr.2022.102048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 11/01/2022] Open
Abstract
Mesotheliomas of the tunica vaginalis testis are very uncommon tumors, with rare cases published in the literature. This report demonstrates a case in with such a tumor was diagnosed in a 50-year-old man who presented to the emergency room with mild, acute scrotal pain and swelling, without previously known scrotal pathology. It is noted that sonographers should be aware of the typical characteristics that allow for suspecting malignancy in scrotal sonography performed in the emergency setting; this was particularly important in this case. Surgical pathology analysis of the right radical orchiectomy specimen confirmed the diagnosis.
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10
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von Amsberg G, Sehovic M, Hartmann M, Bokemeyer C. [Diagnosis and treatment of rare testicular tumors using the example of malignant mesothelioma of the tunica vaginalis testis and Sertoli cell tumors]. Urologe A 2021; 60:872-879. [PMID: 34185119 DOI: 10.1007/s00120-021-01575-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rare tumors of the testis not originating from germinal epithelium are a diagnostic and therapeutic challenge. OBJECTIVES To present current approaches in rare tumors of the testis using the examples of Sertoli cell tumor (SCT) and malignant mesothelioma of the tunica vaginal testis (MMTVT). METHODS A literature search in PubMed and the abstract databases of ASCO and ESMO was performed. Articles and book chapters were selected based on relevance to everyday treatment. RESULTS The low incidence of testicular tumors not originating from the germinal epithelium makes a standardized approach difficult. Diagnosis and treatment depend on the underlying diagnosis. While most SCT are benign, malignant subtypes require extensive resection including metastatic surgery if complete resection is possible. In MMTVT, multimodality treatment concepts are followed, according to the malignant mesotheliomas of the pleura. CONCLUSION Systematic registration of rare testicular tumors and comprehensive molecular pathological analysis are urgently needed to improve the understanding of tumor biology and to develop new therapeutic strategies.
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Affiliation(s)
- G von Amsberg
- II. Medizinische Klinik, Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
- Martini-Klinik, Prostatakrebszentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
| | - M Sehovic
- Klinik für Urologie und Kinderurologie, Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Deutschland
| | - M Hartmann
- Klinik und Poliklinik für Urologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - C Bokemeyer
- II. Medizinische Klinik, Onkologisches Zentrum, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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11
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Karabacakoğlu B, Kısa E, Özbilen MH, Karademir B, Yardım S, Çelik O, Süelözgen T, İlbey YÖ. Malignant mesothelioma of tunica vaginalis: Two extremely rare case reports. Urologia 2021:3915603211022942. [PMID: 34105419 DOI: 10.1177/03915603211022942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Burak Karabacakoğlu
- Urology Department, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Erdem Kısa
- Urology Department, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mert Hamza Özbilen
- Urology Department, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Barış Karademir
- Urology Department, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Serdar Yardım
- Pathology Department, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Orçun Çelik
- Urology Department, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Tufan Süelözgen
- Urology Department, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkey
| | - Yusuf Özlem İlbey
- Urology Department, University of Health Sciences Tepecik Education and Research Hospital, Izmir, Turkey
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Paul PAM, Calton N, Arnestina S, Mammen KJ. Paratesticular tumors. A clinicopathological study from a single tertiary hospital in North India. Ann Diagn Pathol 2020; 50:151658. [PMID: 33189965 DOI: 10.1016/j.anndiagpath.2020.151658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Paratesticular tumors (PTT) are rare and form a heterogenous group, ranging from benign to malignant high grade sarcomas. This study was undertaken to describe the clinicopathological spectrum of PTTs received over a 20-year period. METHODS All primary and secondary PTTs diagnosed from 2000 to 2019 in the pathology department of a tertiary care hospital in North India were retrospectively reviewed. Gross, histopathological features and immunohistochemistry (IHC) findings were correlated with clinical details. RESULTS A total of 169 intra-scrotal tumors were diagnosed during the study period, out of which there were 30 PTTs (in 27 patients) comprising 17.75%. Age range was 4 to 85 years (median 58 years). Benign PTTs were the commonest (n = 21, 70%), followed by metastasis to the paratesticular region (n = 6, 20%) and then primary malignant PTTs (n = 3, 10%). The commonest benign PTT was lipoma (n = 16, 76.19%), followed by adenomatoid tumor (n = 3, 14.28%) with one case each (4.76%) of cellular angiofibroma and hemangioma. Among primary malignant PTT, there were two cases of rhabdomyosarcoma, and one case of biphasic malignant mesothelioma. Metastatic tumors included four cases of prostatic adenocarcinoma, and one case each of pancreatic signet ring cell carcinoma and clear cell renal cell carcinoma. CONCLUSION PTTs show a wide clinicopathological spectrum. Benign PTTs are commoner than malignant PTTs. Meticulous grossing and histopathological examination supplemented by IHC is essential for an accurate diagnosis of this heterogenous class of tumors, which influences the role of adjuvant therapy and patient prognosis.
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Affiliation(s)
- Preethi A M Paul
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India.
| | - Nalini Calton
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Sarah Arnestina
- Department of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Kim J Mammen
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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13
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Drevinskaite M, Patasius A, Kevlicius L, Mickys U, Smailyte G. Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature. BMC Cancer 2020; 20:162. [PMID: 32106829 PMCID: PMC7045691 DOI: 10.1186/s12885-020-6648-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 02/17/2020] [Indexed: 12/29/2022] Open
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. Post-surgical 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.
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Affiliation(s)
| | - Ausvydas Patasius
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania.,Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Ugnius Mickys
- National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania.,Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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14
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Vimercati L, Cavone D, Delfino MC, De Maria L, Caputi A, Ferri GM, Serio G. Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register. Environ Health 2019; 18:78. [PMID: 31470859 PMCID: PMC6717382 DOI: 10.1186/s12940-019-0512-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/05/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare disease with a poor prognosis. The diagnosis and management of these lesions are often difficult for pathologists, surgeons, oncologists and occupational physicians. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy except orchidectomy. METHODS A systematic literature review was conducted among the articles published in the English literature on primary MMTVT. Moreover four cases from the Apulia mesothelioma register are reported here. RESULTS Two hundred eighty-nine cases of MMTVT have been reported from 1943 to 2018. Overall asbestos exposure has been investigated only for 58% of all cases reported in this review, while in 41.8% this data are not available. Noteworthy is the fact that in many reports there is not an anamnestic reconstruction of any asbestos exposure. A history of direct occupational, environmental or familial asbestos exposure is found in 27.6% of the cases. The four cases from the Apulia mesothelioma register are all with ascertained occupational exposure to asbestos. CONCLUSIONS The true incidence of asbestos exposure in MMTVT is underestimated because of insufficient information reported in older literature. To establish a broad consensus on the causal relationship between asbestos and MMTVT in the scientific community its necessary to analyze the same variables in the epidemiological studies. In general it should be recommended that a positive history of exposure to asbestos or to asbestos-containing materials are at risk for the development of a MMTVT and should be monitored.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Domenica Cavone
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Maria Celeste Delfino
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Gabriella Serio
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
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15
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Nazemi A, Nassiri N, Pearce S, Daneshmand S. Testicular Mesothelioma: An Analysis of Epidemiology, Patient Outcomes, and Prognostic Factors. Urology 2019; 126:140-144. [PMID: 30668959 DOI: 10.1016/j.urology.2019.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To characterize demographic features, clinical characteristics, and oncologic outcomes of mesothelioma of the testis. METHODS A population based search was performed using the National Cancer Institute's SEER 18 database. Patients diagnosed with malignant mesothelioma of the male genital organs from 1973 to 2015 were identified. Data on patient age, race, tumor laterality, histologic subtype, tumor extent, tumor size, tumor grade, treatment, cause of death, and survival months was collected. Primary outcomes were overall survival (OS) and disease-specific survival (DSS). RESULTS A total of 113 patients with testicular mesothelioma were identified. The 5-year OS and DSS for all patients was 49% and 58%, and the 10-year OS and DSS was 33% and 45%, respectively. Biphasic mesotheliomas were associated with worse OS compared to general mesotheliomas and epithelioid subtypes (P = .043 and P = .039, respectively). Median survival time was not reached in patients with T1 disease while OS was 1.7 years and DSS was 1.8 years for patients with T4 disease (OS P = .002, DSS P <.001). Tumors greater than or equal to 4 cm were associated with worse OS and DSS (OS P = .025, DSS P = .047). CONCLUSION This rare malignancy has significant mortality, with poor survival associated with biphasic subtypes, higher disease stage, and a critical tumor size cutoff of 4 cm.
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Affiliation(s)
- Azadeh Nazemi
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Nima Nassiri
- Institute of Urology, University of Southern California, Los Angeles, CA; USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Shane Pearce
- Institute of Urology, University of Southern California, Los Angeles, CA; USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California, Los Angeles, CA; USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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16
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Zhang N, Fu N, Peng S, Luo X. Malignant mesothelioma of the tunica vaginalis testis: A case report and literature review. Mol Clin Oncol 2017; 7:1053-1056. [PMID: 29285372 DOI: 10.3892/mco.2017.1450] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/11/2017] [Indexed: 11/06/2022] Open
Abstract
Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor without specific clinical manifestations, mainly including hydrocele formation and a painless mass. We herein present the case of a patient with hydrocele of the left testis, without any other complaints. Tunica vaginalis subinvolution was performed, and postoperative pathological examination revealed a malignant mesothelioma arising from the left tunica vaginalis testis. Whole-body positron emission tomography-computed tomography (PET-CT) and subsequent abdominal and pelvic magnetic resonance imaging (MRI) revealed no evidence of local lymphadenopathy. Radical left orchiectomy was performed after the pathological diagnosis. The pathological examination after the second surgery demonstrated that the tumor had invaded the adjacent periorchium and spermatic cord, but there was no evidence of local lymph node metastasis. Pemetrexed and cisplatin were administered at a dose of 900 and 130 mg, respectively, on the first day of a 28-day cycle. After 6 months of therapy, the disease had not progressed on abdominal and pelvic PET-CT and MRI. The patient was still followed up in our urology outpatient clinic at the time of the present report. Although testicular hydrocele is a common and easily diagnosed condition, detailed medical history and physical examination are required. Thus, when clinicians encounter patients with testicular hydrocele, a variety of possible causes must be considered, including testicular or paratesticular tumors, even rare tumors such as mesothelioma of the tunica vaginalis testis.
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Affiliation(s)
- Neng Zhang
- Department of Urology, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, P.R. China
| | - Ni Fu
- Department of Urology, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, P.R. China
| | - Su Peng
- Department of Urology, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, P.R. China
| | - Xu Luo
- Department of Urology, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou 563003, P.R. China
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17
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Mezei G, Chang ET, Mowat FS, Moolgavkar SH. Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis. Ann Epidemiol 2017; 27:348-359.e11. [PMID: 28527639 DOI: 10.1016/j.annepidem.2017.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 01/10/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Malignant mesothelioma most commonly arises in the pleura and peritoneum but also occurs rarely at other anatomical sites with mesothelial tissue, namely, the pericardium and tunica vaginalis testis (TVT). This review provides a better understanding of the epidemiology of mesothelioma of these extrapleural sites. METHODS We conducted a systematic review of the epidemiologic and clinical literature on pericardial mesothelioma and mesothelioma of the TVT. We also analyzed U.S. Surveillance, Epidemiology, and End Results cancer registry data to describe incidence patterns of these malignancies. RESULTS An etiologic role of asbestos exposure has been hypothesized for pericardial and TVT mesotheliomas, but no analytical case-control epidemiologic studies exist to test this relationship. A substantial proportion of cases with these malignancies report no known asbestos exposure. In large occupational cohorts with heavy asbestos exposures, no cases of pericardial or TVT mesothelioma have been reported. Trends in the incidence of these malignancies do not match those of pleural mesothelioma, which correspond to historical trends of commercial asbestos use. A male preponderance of pericardial mesothelioma is not evident. CONCLUSIONS In the absence of analytic epidemiologic studies, the etiologic role of environmental risk factors for mesothelioma of the pericardium and TVT remains elusive.
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Affiliation(s)
- Gabor Mezei
- Health Sciences Center, Exponent, Inc., Menlo Park, CA.
| | - Ellen T Chang
- Health Sciences Center, Exponent, Inc., Menlo Park, CA
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18
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Maheshwari PN, Abiola OO, Wagaskar VG, Oswal AT. Hydrocele with a surprise: Malignant mesothelioma of the tunica vaginalis - Case report and review of literature. Urol Ann 2017; 9:110-112. [PMID: 28216946 PMCID: PMC5308028 DOI: 10.4103/0974-7796.198877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hydrocele is a very common condition that is simple to evaluate and treat. Management of hydrocele is usually delegated to the junior members of the surgical team. Sometimes this simple condition can spring huge surprises. A 20-year-old man presented with acute onset large, painless fluctuant left hemi-scrotal swelling. Scrotal ultrasonography showed thickened tunica vaginalis. A diagnosis of left hydrocele was made and repair by excision of sac was planned. During the procedure, the sac was found studded with red nodular growths; histopathology reported malignant mesothelioma of tunica vaginalis. Metastatic evaluation showed extensive retroperitoneal lymph nodal involvement. Despite receiving adjuvant chemotherapy with radiotherapy patient died due to extensive metastasis within 16 months. This case is presented for rarity of diagnosis, young age of presentation, absence of etiological factor and rapidly progressive clinical course.
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Affiliation(s)
| | - Olajide O Abiola
- Department of Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Vinayak G Wagaskar
- Department of Urology, Seth G.S. Medical College and Hospital, Mumbai, Maharashtra, India
| | - Ajay T Oswal
- Department of Urology, Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
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19
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Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA. Cancer Causes Control 2016; 27:1487-1489. [PMID: 27812913 DOI: 10.1007/s10552-016-0825-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Exposure to asbestos is thought to cause the large majority of pleural mesotheliomas in the USA. It is unknown whether asbestos exposure plays a role in the etiology of rarer forms of mesothelioma, e.g., those located in the pericardium or in the tunica vaginalis of the testis. In order to address this question, we sought to determine whether geographic patterns of incidence of these mesotheliomas have paralleled those of pleural mesotheliomas. METHODS We used age-adjusted incidence data from the nine populations served by the National Cancer Institute's Surveillance, Epidemiology, and End Results program during 1973-2011. Among men ages ≥50 years, we compared the incidence of pericardial and paratesticular mesotheliomas, respectively, with the incidence of pleural mesothelioma across the nine populations. RESULTS The rate of pleural mesothelioma was approximately twice as high in the San Francisco-Oakland (SFO) and Seattle-Puget Sound (SPS) areas compared to the other regions. In contrast, rates of paratesticular and pericardial mesotheliomas were not elevated in SFO (n = 3 paratesticular, 1 pericardial) or SPS (n = 4 paratesticular, 1 pericardial) relative to other regions. CONCLUSIONS The results of this ecologic study do not support a role for asbestos exposure in the etiologies of either pericardial or paratesticular mesotheliomas; however, this study was limited by small numbers and was unable to directly ascertain asbestos exposure.
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20
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Ahmed Z, Singh S, Mangal A, Mittal A. Primary malignant mesothelioma of the spermatic cord. BMJ Case Rep 2016; 2016:bcr-2016-214602. [PMID: 27045050 DOI: 10.1136/bcr-2016-214602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Primary spermatic cord malignant mesothelioma is an extremely rare tumour with only 12 cases reported so far. It is an aggressive tumour with a high recurrence rate. A 45-year-old man presented with a slow growing right inguinal swelling for the past 1 year. Physical examination revealed a well-circumscribed, hard, non-reducible swelling palpable along the medial extent of the inguinal canal with no cough impulse. Fine-needle aspiration cytology suggested metastatic carcinoma. Contrast-enhanced CT of the thorax and abdomen did not reveal any primary. Right high inguinal orchidectomy was performed at another institution. Postoperative histopathological examination (HPE) and immunohistochemistry suggested biphasic malignant mesothelioma with resected margin positive. The patient was referred to us for revision surgery and adjuvant therapy. Postoperative course was uneventful. Currently, he is undergoing radiotherapy.Surgery is the first-line treatment. Patients should receive adjuvant radiotherapy and/or chemotherapy and long-term follow-up surveillance.
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Affiliation(s)
- Zeeshan Ahmed
- Division of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Suresh Singh
- Division of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Akshay Mangal
- Division of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Alka Mittal
- Department of Pathology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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