Hydrocele with a surprise: Malignant mesothelioma of the tunica vaginalis - Case report and review of literature

Our plain-English summary of Hydrocele with a surprise: Malignant mesothelioma of the tunica vaginalis - Case report and review of literature, by P.N. Maheshwari, O.O. Abiola, V.G. Wagaskar, et al (Urology Annals, 2017).

The study

• Authors: P.N. Maheshwari, O.O. Abiola, V.G. Wagaskar, A.T. Oswal
• Journal: Urology Annals
• Published: 2017;9(1):110-112
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

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.

In plain English

This article reported the case of a 20-year-old Indian man with malignant mesothelioma of the tunica vaginalis, a rare cancer of the lining around the testis, and briefly discussed earlier published reports. As a single case, it describes what happened to one patient. He had a painless swelling of the left side of the scrotum for 3 weeks. Ultrasound showed a normal testis with irregular thickening of the sac wall, and a routine hydrocele (fluid collection) operation was planned. During surgery the sac was lined with numerous red, firm nodules of 15–18 mm, and tissue examination showed malignant mesothelioma. The authors reported that he had no history of asbestos exposure. A CT scan showed large lymph nodes beside the aorta and the left kidney (4 cm × 3 cm). After removal of the testis, the growth recurred within ten days, measuring 6 cm × 4 cm and involving the scrotal skin. He received Adriamycin-based chemotherapy with local radiotherapy, had an initial partial response, and died within 16 months with extensive metastasis. The authors concluded that awareness of the disease, aiming at accurate diagnosis before surgery, may improve outcomes.

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 with a brief review of the literature
• Who was studied: one 20-year-old Indian man with a painless swelling of the left side of the scrotum lasting 3 weeks; the authors are based at hospitals in India and Nigeria, and the article does not state when the patient was treated
• Exposure: the authors reported that the patient had no history of exposure to asbestos and no associated risk factors
• Main results:
  • Ultrasound before surgery showed a normal testis with irregular thickening of the sac wall
  • During surgery the parietal surface of the tunica vaginalis was lined with numerous red, firm, vascular nodules of 15–18 mm; the testis and epididymis were normal
  • Tissue examination (histopathology) showed malignant mesothelioma of the tunica vaginalis
  • CT of the abdomen and pelvis showed large left para-aortic and left renal hilar lymph nodes (4 cm × 3 cm)
  • Ten days after radical orchiectomy with excision of the scrotal scar, there was a large recurrence (6 cm × 4 cm) with extensive involvement of the scrotal skin
  • After Adriamycin-based chemotherapy with local radiotherapy, there was an initial partial response, but the patient died within 16 months with extensive metastasis
• The authors' conclusion: The authors reported the case because of the rarity of the disease, the patient's young age, the absence of associated risk factors and the rapidly progressive course. They concluded that awareness of the disease, aiming at accurate diagnosis before surgery, may improve outcomes.

Topics

Medical terms in this study, explained in our Lexicon: Hydrocele, Mesothelioma, Tunica Vaginalis, Histopathology, Chemotherapy, Metastasis.

Related studies

• 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: presenting with intermittent scrotal pain and hydrocele — T. Esen, O. Acar, et al. (2012)
• Malignant mesothelioma of the tunica vaginalis testis: A rare cause of hydrocele — M. de Sá Barrêto Callou Peixoto, M.K. Bernardo Soares, et al. (2022)
• Mesothelioma of the tunica vaginalis in a patient with giant hydrocele — C.S. Montón, J.F. Esparza, et al. (2016)
• Malignant Epithelioid Mesothelioma of the Tunica Vaginalis Testis Presenting as Hydrocele in a Kidney Transplant Recipient — B.M. Behers, C.W. Guske, et al. (2024)
• When a hydrocele is more than a hydrocele: Warning symptoms and signs of malignant mesothelioma of the tunica vaginalis testis — J. Cornfield, M. Lee, et al. (2026)

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