Chronic Inflammatory Tunica Vaginalis Masses With Haemorrhagic Hydrocoele Fluid: A Rare Finding in a Patient With Vaginal Hydrocoele

Our plain-English summary of Chronic Inflammatory Tunica Vaginalis Masses With Haemorrhagic Hydrocoele Fluid: A Rare Finding in a Patient With Vaginal Hydrocoele, by P.E. Ngwu, I.E. Ihedoro, C.P. Ohiarah (Curēus, 2025).

The study

• Authors: P.E. Ngwu, I.E. Ihedoro, C.P. Ohiarah
• Journal: Curēus
• Published: 2025;17(10):e94247
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Tunica vaginalis masses are a part of the paratesticular masses, which are rare. The combination of the finding of tunica vaginalis masses with haemorrhagic hydrocele fluid will make for a high index of suspicion of a mitotic lesion. Most reported cases of tunica vaginalis masses are mesotheliomas, most of which present as painless scrotal swellings with hydrocele. Our patient is a 58-year-old man who presented with a painless swelling involving the left hemiscrotum, in which the histopathological findings following surgery turned out to be chronic inflammatory tunica vaginalis masses. Chronic Inflammatory tunica vaginalis masses, even though rare, should be borne in mind when thinking of possible differential diagnosis in a patient with painless scrotal swelling.

Copyright © 2025, Ngwu et al.

In plain English

This case report described one 58-year-old man with a painless swelling on the left side of the scrotum, first noticed four years earlier. The authors reported that he had no history of trauma, previous groin or scrotal surgery, radiation therapy, or exposure to asbestos. Examination and a scrotal ultrasound scan pointed to a hydrocele, a fluid collection around the testicle. During surgery, about 250 mL of bloody fluid was drained. The surgeons also found two free-floating soft masses, the largest about 2.5 cm across, and stalked masses on the lining around the testicle (the tunica vaginalis). These findings led the authors to strongly suspect cancer. In their discussion they listed malignant mesothelioma of the tunica vaginalis among the cancers to consider. The part of the lining carrying the masses was removed. Microscope examination of the tissue showed chronic inflammation with no evidence of malignancy, and follow-up over the past year was uneventful. The authors concluded that chronic inflammatory tunica vaginalis masses, though uncommon, should be considered in patients with painless scrotal swelling. They added that a definitive diagnosis relies on examining the tissue after surgery.

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 58-year-old man with a painless left hemiscrotal swelling noticed four years before presentation; the place and dates of treatment are not stated
• Exposure: No exposure was studied; the authors report the patient had no history of radiation therapy or asbestos exposure
• Main results:
  • Physical examination suggested a vaginal hydrocele, which a scrotal ultrasound scan confirmed
  • At surgery, about 250 mL of haemorrhagic (bloody) fluid was drained from the tunica vaginalis
  • Two free-floating greyish soft masses were found in the fluid, the largest about 2.5 cm in diameter, along with pedunculated masses of varying sizes on the parietal layer of the tunica vaginalis
  • The haemorrhagic fluid, thickened tunica vaginalis and masses gave the authors a high suspicion of malignancy; in their discussion they list malignant mesothelioma of the tunica vaginalis among the cancers to consider when a hydrocele contains haemorrhagic fluid
  • A modified Jaboulay's hydrocoelectomy was performed, with excision of the part of the tunica vaginalis sac bearing the masses
  • Histological analysis of the specimen showed chronic inflammation with no evidence of malignancy
  • The patient was discharged on the day of surgery, and post-operative visits over the past year were uneventful
• The authors' conclusion: The authors concluded that chronic inflammatory tunica vaginalis masses, although uncommon, should be considered in the differential diagnosis for painless scrotal swelling, and that even when findings point toward malignancy, a definitive diagnosis relies on post-operative histological analysis

Topics

Medical terms in this study, explained in our Lexicon: Tunica Vaginalis, Paratesticular, Hydrocele, Mesothelioma, Differential Diagnosis.

Related studies

• Mesothelioma of the tunica vaginalis testis: a rare malignancy mimicking more common inguino-scrotal masses — P.J. Schure, K.C. van Dalen, et al. (2006)
• Idiopathic chronic hematocele mimicking a mesothelioma of the tunica vaginalis testis — M. Bibi, A. Sellami, et al. (2018)
• Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology — S.C. Gupta, A.K. Gupta, et al. (1998)
• Radiologic findings of mesothelioma at the tunica vaginalis — S.W. Doo, K.H. Cho, et al. (2012)
• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)
• Malignant mesothelioma of tunica vaginalis testis: Report of a very rare case with review of the literature — E. Trenti, S.M. Palermo, et al. (2018)

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