Malignant Mesothelioma of the Testes with Retroperitoneal Recurrence and Resection in an 80-Year-Old Male and Review of the Literature

Our plain-English summary of Malignant Mesothelioma of the Testes with Retroperitoneal Recurrence and Resection in an 80-Year-Old Male and Review of the Literature, by W.C.I. Janes, S. Al-Asaaed, P.H. Johnston (Case Reports in Oncology, 2023).

The study

• Authors: W.C.I. Janes, S. Al-Asaaed, P.H. Johnston
• Journal: Case Reports in Oncology
• Published: 2023;16(1):698-704
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma of the testes is an aggressive, yet rare urogenital malignancy, accounting for an infinitesimally small number of oncologic diagnoses. This infrequent occurrence is accompanied by a relative lack of knowledge surrounding this disease, thus limiting management options beyond surgical intervention. Oftentimes, these malignancies present with a poor prognosis despite early intervention and only worsen in the event of metastatic spread with poor survival and limited response to treatment, if any. Our case documents positive patient outcomes following the use of aggressive surgical intervention in the management of a metastatic testicular mesothelioma. A healthy 80-year-old male with sudden painless testicular swelling requiring radical orchidectomy following failed initial conservative management. Pathologically, the specimen was diagnosed as malignant mesothelioma of the right testis with involvement of the tunica albuginea and tunica vaginalis. Following disease recurrence at 82 years of age, the patient subsequently opted for an open right-sided template non-nerve sparing retroperitoneal lymph node dissection which was undertaken without complication. Malignant mesothelioma of the testes remains an ominous diagnosis with historically poor outcomes and for which surgical intervention remains the mainstay of treatment. The retroperitoneal lymphatic drainage represents the most common route of metastatic spread for testicular tumours; however, retroperitoneal lymph node dissection has rarely been employed in this patient population and never in an individual of this age. Our findings contribute to the growing literature surrounding these rare malignancies and outline the importance of considering both patient autonomy and the clinical picture in disease management.

© 2023 The Author(s). Published by S. Karger AG, Basel.

In plain English

This article was a case report of one patient, with a discussion of earlier published literature. An 80-year-old man with minimal past medical history and no known history of asbestos exposure developed sudden, painless swelling of the right testis in September 2020. Antibiotics did not help. An ultrasound showed a lesion invading the right testicle, and the testis was surgically removed. Testicular tumour markers in the blood were normal. Pathology found malignant mesothelioma of the testis, mainly involving the tunica albuginea and also the tunica vaginalis. Resection margins were negative, but lymphovascular invasion was present. The patient received no systemic therapy and was followed with imaging. About 16 months later, a February 2022 PET-CT scan showed enlarged retroperitoneal lymph nodes consistent with spread of the disease. The patient chose a right-sided retroperitoneal lymph node dissection, which was done without complication. Six of sixteen interaortocaval nodes contained cancer. The patient was reported as currently well and on active surveillance. The authors concluded that theirs was the first report of this operation being used in a patient of this age.

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 of a single patient, with a narrative discussion of published literature (not a systematic review)
• Who was studied: one healthy 80-year-old Caucasian man who presented in September 2020; the authors are based in St. John's, Newfoundland and Labrador, Canada
• Exposure: no known history of asbestos exposure; the article names no fiber type, product or job
• Main results:
  • In this patient, the removed specimen was diagnosed as malignant mesothelioma of the testis.
  • In this patient, the testicular tumour markers alpha-fetoprotein, lactate dehydrogenase and beta human choriogonadotropin were normal.
  • In the first surgery, the spermatic cord resection margins were negative for tumour, but lymphovascular invasion was present.
  • The patient was not offered systemic therapy and remained well until the disease recurred at about 16 months.
  • The retroperitoneal lymph node dissection was carried out without complication.
  • In the dissection specimen, 6 of 16 interaortocaval lymph nodes contained cancer, and extranodal extension and large vessel invasion were present.
  • At the time of writing, the patient was well and on active surveillance.
• The authors' conclusion: The authors concluded that their case is one of the few to use retroperitoneal lymph node dissection for metastatic testicular mesothelioma and the first in a patient of this age. They said it highlights the clinical picture together with patient autonomy in managing the disease.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Prognosis, Testicular Mesothelioma, Tunica Vaginalis, Retroperitoneal Lymph Node Dissection (RPLND).

Related studies

• Timely Surgical Resection Achieved Prolonged Remission in Patients With Malignant Mesothelioma of the Tunica Vaginalis Testis and Retroperitoneal Recurrence — M. Radovanovic, U. Kojic, et al. (2024)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Soluble Mesothelin-Related Peptides to Monitor Recurrence After Resection of Pleural Mesothelioma — B.M. Burt, H.S. Lee, et al. (2017)
• Rectus abdominis muscle resection for abdominal wall recurrence of mucinous adenocarcinoma or peritoneal mesothelioma — T. Yan, P. Sugarbaker (2008)
• Chest wall resection for mesothelioma recurrence after surgery — P. Bertoglio, O. Fanucchi, et al. (2016)
• Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection — M. Rodríguez, H.R. Mallidi, et al. (2018)

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