Identification and Management of Testicular Mesothelioma Identified Intraoperatively: A Case Series

Our plain-English summary of Identification and Management of Testicular Mesothelioma Identified Intraoperatively: A Case Series, by T. Sweeney, I. Doan, R.L. Grubb (Curēus, 2024).

The study

• Authors: T. Sweeney, I. Doan, R.L. Grubb
• Journal: Curēus
• Published: 2024;16(5):e61190
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Testicular mesothelioma lacks the characteristic presentation of testicular malignancy and often has normal biomarkers at the time of diagnosis causing this malignancy to be overlooked and diagnosed intraoperatively during elective scrotal surgery. We present two cases of testicular mesothelioma that were diagnosed incidentally during hydrocelectomy. These cases emphasize the importance of considering testicular mesothelioma during hydrocele and scrotal mass workup and demonstrate the need for standardized guidelines for the management of testicular mesothelioma.

Copyright © 2024, Sweeney et al.

In plain English

In this case series, urologists at the Medical University of South Carolina described two men aged 77 and 75. In both, mesothelioma of the testicular lining was found unexpectedly during surgery for a hydrocele, a scrotal fluid collection. Neither man had a history of asbestos exposure. Both men's earlier ultrasounds looked most like a harmless hydrocele. Nodules were seen only at surgery. The first man was referred to the authors' institution after his first operation elsewhere. There, further surgery confirmed epithelioid-type malignant mesothelioma, and lymph node surgery found spread to several lymph nodes. He received carboplatin/pemetrexed chemotherapy, and his disease had not progressed one year after diagnosis. The second man had the testicle removed through the groin in the same operation. Pathology showed malignant mesothelioma without disease in the spermatic cord. He moved away before planned lymph node surgery. The authors concluded that the cases show the importance of primary surgical treatment when testicular mesothelioma is suspected, and the lack of guidelines when it is found during surgery. They wrote it is unknown whether earlier scrotal procedures caused the first man's spread.

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 series (two case reports)
• Who was studied: Two men, aged 77 and 75, described by authors from the Department of Urology, Medical University of South Carolina, Charleston, USA. The first man was initially seen at an outside urology office and later referred to the authors' institution. Dates of treatment are not given.
• Exposure: Neither patient had asbestos exposure. The second patient had a history of high-risk non-muscle-invasive bladder cancer.
• Main results:
  • Patient 1: nodules were found throughout the right tunica vaginalis during a hydrocelectomy. The first pathology showed an atypical mesothelial proliferation, but it could not be determined whether it was malignant or papillary mesothelioma.
  • Patient 1: after a right radical inguinal orchiectomy and hemiscrotectomy, final pathology showed epithelioid-type malignant mesothelioma involving the paratesticular soft tissue, rete testis and spermatic cord.
  • Patient 1: bilateral retroperitoneal lymph node dissection found metastatic disease in several lymph nodes.
  • Patient 1: after adjuvant carboplatin/pemetrexed chemotherapy, he had no disease progression one year after diagnosis.
  • Patient 2: ultrasound showed a 1 cm right spermatocele, an 8 cm right hydrocele and a 3 cm left hydrocele. At hydrocelectomy, multiple small nodules were seen. After an inguinal right radical orchiectomy with spermatic cord excision, final pathology showed malignant mesothelioma without disease in the spermatic cord.
  • In both patients, ultrasound findings before surgery were most consistent with a benign hydrocele.
• The authors' conclusion: The authors concluded that the two cases demonstrate the importance of primary surgical treatment when testicular mesothelioma is suspected, and the lack of guidelines when it is identified during surgery. They also stated that retroperitoneal lymph node dissection after diagnosis is advantageous when tumor spread is a concern.
• Limitations the authors state:
  • The authors stated it is unknown whether the first patient's extensive metastatic disease was caused by spread during the hydrocele drainage and hydrocelectomy.
  • The authors stated that the risk of tumor spread from the second patient's initial incision through the scrotum is not known.

Topics

Medical terms in this study, explained in our Lexicon: Testicular Mesothelioma, Biomarker, Hydrocelectomy, Hydrocele.

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