Diagnostic and Therapeutic Management of Mesothelioma of the Tunica Vaginalis Testis: A Population-Based Study in Italy

Our plain-English summary of Diagnostic and Therapeutic Management of Mesothelioma of the Tunica Vaginalis Testis: A Population-Based Study in Italy, by G.L. Ceresoli, S. Stella, B. Dallari, et al (Cancers, 2025).

The study

• Authors: G.L. Ceresoli, S. Stella, B. Dallari, R. Perduri, C. Storchi, L. Vimercati, S. Piro, L. Giovannetti, U. Fedeli, V. Casotto, E. Migliore, A. Stura, C. Genova, L. Benfatto, F. Larese Filon, F. D'Agostin, I. Cozzi, I.F. Angelillo, E. Spata, S. Murano, I. Grappasonni, C. Pascucci, M. Melis, F. Stracci, A. Marinaccio, A. Binazzi, D. Consonni, C. Mensi
• Journal: Cancers
• Published: 2025;17(19)
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma of the tunica vaginalis testis (MTVT) is an exceedingly rare tumor. We performed a registry-based study on MTVT patient management and survival in Italy.

Methods: Cases were extracted from the dataset of the Italian National Mesothelioma Registry. A descriptive analysis of patient characteristics, including asbestos exposure, clinical presentation, diagnostic work-up and therapeutic management, was performed. Overall survival was evaluated. We calculated hazard ratios (HR) and 95% confidence intervals (CI) for selected variables by fitting univariate and multivariable Cox models.

Results: Overall, 104 patients with MTVT were included. Median age was 72 years (range 17-92). Epithelioid histotype was the most frequent. Previous asbestos exposure was identified in two thirds of cases. Data on diagnostic and therapeutic management were available for 74 patients (71%). The most frequent presentations were scrotal swelling/mass, hydrocele and inguinal pain. All patients underwent surgery, mostly with orchi-funicolectomy. Adjuvant therapy was administered to 15 patients (20%). Overall median survival was 26.2 months (95% CI 22.1-52.1); 3-, 5- and 10-year survival was 49%, 30% and 18%. Older age at diagnosis and presence of distant metastasis (HR 1.91, CI: 0.85-4.26) were negative prognostic factors. Adjuvant therapy was associated with higher mortality (HR 2.54, CI: 1.25-5.15), indicating a more advanced stage at diagnosis.

Conclusions: Surgery remains the mainstay of treatment for MTVT; adjuvant therapy in our study did not improve outcome. Data from cancer registries are essential for rare cancers, but they should be integrated routinely with additional diagnostic and therapeutic information.

In plain English

This study used Italy's National Mesothelioma Registry (ReNaM) to describe men with mesothelioma of the tunica vaginalis testis (MTVT), a cancer of the lining around the testis. Between 1994 and 2021, 104 cases were registered, a crude rate of 0.17 per million person-years. Among cases whose exposure was assessed by interview, about two thirds had previous asbestos exposure, almost all of it occupational. The article did not name fiber types. Treatment details were available for 74 patients. The most common presentation was scrotal or testicular swelling or a mass (52 of 74). All 74 had surgery, mostly orchi-funicolectomy, and 15 also received chemotherapy and/or radiotherapy. For these 74 patients, median survival was 26.2 months (95% CI 22.1–52.1), and 49%, 30% and 18% were alive at 3, 5 and 10 years. Patients aged 65 or older had much worse survival. Patients given additional therapy had a higher risk of death, which the authors attributed to those patients having more advanced disease. The authors concluded that surgery remains the mainstay of treatment, and they noted incomplete clinical data and possible selection bias.

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: Population-based registry study: descriptive analysis plus survival analysis (Kaplan–Meier and Cox regression) of cases in the Italian National Mesothelioma Registry
• Who was studied: 104 patients with MTVT registered in Italy from January 1994 to December 2021. Median age was 72 years (range 17–92). Complete treatment data were available for 74 (71%).
• Exposure: Lifetime asbestos exposure was assessed by standardized interview of patients or next-of-kin. Fiber types were not reported. Among interviewed cases, 56 (64%) had occupational exposure and 29 (33%) were unexposed. Median latency in occupationally exposed cases was 54 years (range 13–75).
• Main results:
  • The crude incidence rate of MTVT in Italy was 0.17 per million person-years.
  • Among the 74 patients with treatment information, the most frequent presentation was scrotal or testicular swelling or mass (52 of 74, 70%).
  • All 74 patients had surgery, mostly orchi-funicolectomy (58 cases, 78%). 15 (20%) received adjuvant therapy: 9 chemotherapy alone, 2 radiotherapy and 4 both.
  • Overall median survival of the 74 patients was 26.2 months (95% CI 22.1–52.1). The 3-, 5- and 10-year survival rates were 49%, 30% and 18%.
  • Patients aged 65 or older had worse survival than those under 65. The adjusted HR was 6.69 (95% CI 2.77–16.14) for ages 65–74 and 10.50 (4.16–26.50) for ages 75 and over.
  • Distant metastasis at diagnosis (10 of 74 patients) was associated with increased mortality. The crude HR was 3.09 (1.53–6.24) and the adjusted HR was 1.91 (0.85–4.26).
  • Patients who received adjuvant therapy had higher mortality than surgery-only patients. The adjusted HR was 2.54 (1.25–5.15), and median survival was 18.3 vs. 41.9 months. The authors attributed this to confounding by indication.
  • No important survival differences were seen by histological subtype.
• The authors' conclusion: The authors concluded that surgery is the mainstay of MTVT treatment. In their study, adjuvant therapy did not improve outcome, and the role of a multimodality approach remains undefined. They also concluded that registry data are essential but need routine clinical and treatment information.
• Limitations the authors state:
  • Clinical data were sometimes incomplete, and there was no specific data quality evaluation.
  • The registry does not routinely collect clinical presentation, tumor size, T-stage or extent of surgery. These data were nearly complete mainly for Northern Italy, so selection bias is possible.
  • There were few non-epithelioid tumors, which may explain why no prognostic advantage of the epithelioid subtype was seen.
  • Few patients received post-operative treatment, and no prospective or randomized data were available.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Asbestos Exposure, Overall Survival, Hazard Ratio, confidence interval, Epithelioid, Hydrocele.

Related studies

• Pericardial Mesothelioma: Diagnostic and Therapeutic Management, a Population-Based Study in Italy — S. Stella, D. Consonni, et al. (2025)
• Mesothelioma of the Tunica Vaginalis Testis: Diagnostic and Therapeutic Management. A Comprehensive Review, 1982-2024 — S. Stella, G.L. Ceresoli, et al. (2024)
• Peritoneal mesothelioma and asbestos exposure: a population-based case-control study in Italy, 2000-2021 — D. Consonni, E. Migliore, et al. (2025)
• Pleural mesothelioma risk in the construction industry: a case-control study in Italy, 2000-2018 — S. Stella, D. Consonni, et al. (2023)
• Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: a case-control study and epidemiological remarks — A. Marinaccio, D. Consonni, et al. (2020)
• Authors' response: Mezei et al's "Comments on a recent case-control study of malignant mesothelioma of the pericardium and the tunica vaginalis testis" — A. Marinaccio, D. Consonni, et al. (2021)

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