Imaging appearance of cystic and solid mesothelioma of the tunica vaginalis

Our plain-English summary of Imaging appearance of cystic and solid mesothelioma of the tunica vaginalis, by T.D. Hannappel, M.J. DeVries, N.J. Hansen (Radiology Case Reports, 2020).

The study

• Authors: T.D. Hannappel, M.J. DeVries, N.J. Hansen
• Journal: Radiology Case Reports
• Published: 2020;15(7):809-811
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We present the case of a 32-year-old male who presented with a growing scrotal mass initially diagnosed as benign adenomatoid tumor on ultrasound 6 years prior. Repeat ultrasound showed an abnormal extra-testicular mass with nodular and cystic components and internal vascularity. A computed tomography scan of the abdomen and pelvis confirmed a right extra-testicular scrotal mass with cystic and solid enhancing components. The patient underwent radical orchiectomy and postoperative pathology diagnosed mesothelioma of the tunica vaginalis of the testis. Mesothelioma of the tunica vaginalis of the testis is an exceptionally rare disease. We discuss the risk factors, imaging features, and treatment strategies of the disease.

© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

In plain English

This article was a case report about one patient. The patient was a 32-year-old man with intellectual disability. At a routine check-up his doctors found fullness in his right scrotum. Six years earlier, an ultrasound had shown a small solid mass, 0.9 × 0.4 cm, just above the right testicle, which was read at the time as a benign adenomatoid tumor. A repeat ultrasound found a moderate-sized fluid collection (hydrocele) and an abnormal area of 6.0 × 3.2 × 4.4 cm containing cystic and solid nodular parts, with blood flow inside the solid parts. A CT scan showed solid and cystic nodules that extended up to the level of the inguinal canal. He had his right testicle surgically removed (radical orchiectomy). Pathology confirmed mesothelioma of the tunica vaginalis, the lining around the testis, with no tumor at the edges of the removed tissue. He was judged not a candidate for chemotherapy, and careful surveillance was chosen as the course of action. The authors stated that he had no known risk factors for mesothelioma, so no asbestos exposure was known for him. The authors described this disease as exceptionally rare.

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), with a discussion of published literature
• Who was studied: one 32-year-old man with intellectual disability, seen at the University of Nebraska Medical Center, Omaha, Nebraska, USA
• Exposure: No asbestos exposure was known for this patient. The authors stated that he had no known risk factors for mesothelioma, and elsewhere in the article they list asbestos exposure as a risk factor. The article does not describe an exposure history for him.
• Main results:
  • Six years before diagnosis, an ultrasound in this patient showed a small, solid, hypoechoic extra-testicular mass of 0.9 × 0.4 cm just above the right testicle. It was interpreted as a benign adenomatoid tumor.
  • A repeat ultrasound six years later showed a moderate-sized right hydrocele and an abnormal area of 6.0 × 3.2 × 4.4 cm above and to the side of the right testicle. The area had cystic and solid nodular parts, and the solid parts showed internal blood flow on Doppler.
  • Contrast-enhanced CT showed a large right hydrocele with solid and cystic extra-testicular nodules. The enhancing nodules extended upward to the level of the inguinal canal.
  • After radical orchiectomy of the right testicle, pathology confirmed mesothelioma of the tunica vaginalis with negative tumor margins.
  • The patient was judged not to be a candidate for chemotherapy. Given the negative tumor margins and the unestablished role of adjunctive therapies, the doctors decided that a careful surveillance approach would be the course of action.
• The authors' conclusion: The authors described mesothelioma of the tunica vaginalis of the testis as an exceptionally rare disease.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Adenomatoid Tumor, Ultrasound, Orchiectomy, Pathology.

Related studies

• Malignant mesothelioma of the tunica vaginalis testis: unusual sonographic appearance — M.T. Wang, C.W. Mak, et al. (2005)
• Well-differentiated papillary mesothelioma of tunica vaginalis testis of unknown malignant potential: Sonographic appearance — K.W.S. Ko, K.S. Tse, et al. (2018)
• Imaging of mesothelioma of tunica vaginalis testis — M. Bertolotto, I. Boulay-Coletta, et al. (2016)
• Primary malignant mesothelioma of the tunica vaginalis presenting as hydrocele: imaging pitfalls — J. Naidu, N.G. Joseph, et al. (2026)
• Cystic appearance of a malignant peritoneal mesothelioma by ultrasonography and computed tomography: a case report — K.W. Preidler, H. Steiner, et al. (1994)
• Imaging appearance of benign multicystic peritoneal mesothelioma: a case report and review of the literature — V. Mehta, V. Chowdhary, et al. (2017)

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