A case of simultaneous diagnosis of tunica vaginalis testis and pleural mesothelioma

Our plain-English summary of A case of simultaneous diagnosis of tunica vaginalis testis and pleural mesothelioma, by R. Matsuki, S. Ishii, T. Suzuki, et al (Respirology Case Reports, 2022).

The study

• Authors: R. Matsuki, S. Ishii, T. Suzuki, H. Sugiyama
• Journal: Respirology Case Reports
• Published: 2022;10(4):e0937
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 37-year-old man was admitted to our hospital with chest pain and fever. Computed tomography showed pleural effusion and irregularly marginated, elevated lesions inside diffuse pleural thickening. Detailed medical examination showed swelling of the left testicle. 18F-fluorodeoxyglucose positron emission tomography showed uptakes at the thickened pleura and left testis. Pelvic magnetic resonance imaging showed a mass in the left testis with a heterogeneous and partially calcified tumour present interiorly. Thoracoscopy was performed under local anaesthesia, enabling the observation of masses at the pleura and biopsy of the mass, which was diagnosed as malignant pleural mesothelioma. The affected testicle was resected and diagnosed as tunica vaginalis testis mesothelioma. Thus, simultaneous tunica vaginalis testis and pleural mesothelioma were diagnosed. It is necessary to closely examine parts of the body other than the chest.

© 2022 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.

In plain English

This case report described a 37-year-old man with no history of asbestos exposure who came to the authors' hospital with left chest pain and fever. Chest CT showed fluid and thickening of the left pleura, the lining around the lung, and examination found a swollen left testicle. PET scanning showed uptake in both the thickened pleura and the left testis, and pelvic MRI showed a 43 by 35 mm mass in the left testis. A biopsy taken by thoracoscopy under local anaesthesia was diagnosed as malignant pleural mesothelioma. The left testicle was removed. It held a tumour continuous with the tunica vaginalis testis, the membrane around the testis, and that tumour was diagnosed as mesothelioma. The authors could not tell which tumour came first or whether these were two separate cancers. They suggested he may have had other minor risk factors such as simian virus 40, but whether he was infected was not known. The authors concluded that doctors need to closely examine parts of the body other than the chest.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 37-year-old man with no history of asbestos exposure, seen at the authors' hospital (Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan). The article does not give the date.
• Exposure: The patient had no history of asbestos exposure. No fiber type, product or job is described.
• Main results:
  • Chest CT showed pleural effusion (fluid) and pleural thickening on the left side.
  • Examination found that the left testicle was swollen.
  • FDG-PET showed uptake at the thickened pleura and at the left testis.
  • Pelvic MRI showed a 43 by 35 mm mass in the left testis, with a heterogeneous, partially calcified tumour inside it.
  • The pleural biopsy taken during thoracoscopy stained positive for D2-40 and CAM5.2 (as well as calretinin and WT-1) and negative for EMA, desmin, Napsin A, Ber-EP4 and TTF-1. The diagnosis was malignant pleural mesothelioma.
  • In the removed left testicle, the tumour had spread to cover the inner surface of the capsule and was continuous with the tunica vaginalis testis. It was diagnosed as tunica vaginalis testis mesothelioma, so the patient had both tunica vaginalis testis and malignant pleural mesothelioma at the same time.
  • The authors stated that, to the best of their knowledge, this was the first such report.
• The authors' conclusion: The authors concluded that in such cases doctors need to closely examine parts of the body other than the chest.
• Limitations the authors state:
  • The authors could not determine which tumour was the primary cancer, or whether this was a case of two separate cancers.
  • The authors suggested the patient may have had other minor risk factors such as simian virus 40, but whether he was infected was not known.

Topics

Medical terms in this study, explained in our Lexicon: Tunica Vaginalis, Pleural Mesothelioma, Pleural Effusion, Diffuse Pleural Thickening, Pleura, Thoracoscopy, Biopsy, Mesothelioma.

Related studies

• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis — S.S. Chekol, C.C. Sun (2012)
• Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology — S.C. Gupta, A.K. Gupta, et al. (1998)
• Malignant mesothelioma of the tunica vaginalis testis — K. Antman, S. Cohen, et al. (1984)
• Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2017)
• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)

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