Malignant mesothelioma of the tunica vaginalis of the testis without exposure to asbestos

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis of the testis without exposure to asbestos, by A. Goel, A. Agrawal, R. Gupta, et al (Cases Journal, 2008).

The study

• Authors: A. Goel, A. Agrawal, R. Gupta, S. Hari, A.B. Dey
• Journal: Cases Journal
• Published: 2008;1(1):310
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Mesotheliomas are rare tumours that usually are seen in the pleura after asbestos exposure. Mesotheliomas have been reported around the testicular region but are even rarer following trauma, herniorrhaphy and long term hydrocoele.

Case Presentation: An elderly male farmer presented to us with an insidious onset of painless swelling in his left lower limb which gradually progressive. At the time of presentation it had involved his entire limb. A hard palpable mass of size 5 * 4 cms was detected in the left iliac fossa and a testicular enlargement was noted on the left side. The ultrasound of the testes showed that the left testis was enlarged 3.9*3*3.2 cms showing diffusely heterogenous echo-texture and irregular nodular surface with irregular hypoechoic thickening of the scrotal wall with left sided hydrocele. A separate hypoechoic *1.2 cms lesion was visualized in the anterior scrotal wall. FNAC from the scrotal mass showed tumour cells of simialr morphology present singly in monolayered sheets and in three dimensional fragments. The overall immunomorphological features suggested a malignant mesothelioma likely to have arisen from the tunica vaginalis.

Conclusion: In conclusion, though a rare tumor, malignant mesothelioma of the tunica vaginalis of the testis should be considered whenever a paratesticular mass lesion is seen even without a history of trauma or asbestos exposure as is highlighted in this case. Ultrasound findings are helpful and fine needle aspiration of the tumor may assist in arrival at a diagnosis. Surgical orchidectomy remains the modality of treatment.

In plain English

This was a case report from AIIMS, New Delhi, India, about one patient. A 65-year-old male farmer from Bihar had painless swelling of his left leg for two months. He reported no previous surgery or trauma to the region. He had worked as a hired farm worker all his life and gave no history of asbestos exposure in his work. On examination his left testis was enlarged as a hard mass of 10 by 5 by 4 cm. Ultrasound measured the left testis at 3.9 by 3 by 3.2 cm. A CT scan showed a 9 by 7 by 7 cm lymph node mass in the left pelvis. A needle biopsy of the left iliac mass suggested squamous cell carcinoma, but the authors said this did not match the final diagnosis. Fine needle aspiration of the scrotal mass suggested a malignant mesothelioma, likely arising from the tunica vaginalis, the lining around the testis. The patient had a high inguinal orchidectomy (removal of the testis) and was then lost to follow-up. The authors concluded that this tumor should be considered with a mass beside the testis even without a history of trauma or asbestos exposure.

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 (one patient)
• Who was studied: one 65-year-old male farmer from Bihar, seen at the outpatient department of AIIMS, New Delhi, India
• Exposure: No asbestos exposure was reported: the patient had worked as a hired farm worker all his life, gave no history of asbestos exposure in his occupation, and reported no previous surgery or trauma to the region
• Main results:
  • The patient reported no previous surgery or trauma to the region
  • On examination, the left testis was enlarged as a single hard mass of 10 by 5 by 4 cm
  • On ultrasound, the left testis measured 3.9 by 3 by 3.2 cm, with an uneven internal pattern and an irregular nodular surface
  • CT showed a large lymph node mass of 9 by 7 by 7 cm in the left half of the pelvis
  • Tumor marker results for the patient: alpha fetoprotein was 4.64 ng/ml and beta human chorionic gonadotropin was 0.29 mIU/ml, both within the normal ranges the article gives
  • A trucut biopsy of the left iliac mass showed features of squamous cell carcinoma; the authors state this was not consistent with the final diagnosis
  • Tumor cells from fine needle aspiration of the scrotal mass were positive for cytokeratin, epithelial membrane antigen (EMA) and calretinin
  • The overall findings suggested a malignant mesothelioma likely to have arisen from the tunica vaginalis
  • The patient underwent a high inguinal orchidectomy and was then lost to follow-up
• The authors' conclusion: The authors concluded that, though rare, malignant mesothelioma of the tunica vaginalis of the testis should be considered whenever a mass is seen beside the testis, even without a history of trauma or asbestos exposure

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Pleura, Asbestos Exposure, Ultrasound, Hydrocele, Paratesticular.

Related studies

• Fine needle aspiration cytology in malignant mesothelioma of the tunica vaginalis testis — R. Gupta, P. Dey, et al. (2011)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Malignant mesothelioma of the tunica vaginalis testis — K. Antman, S. Cohen, et al. (1984)
• Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2017)
• Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis — S.S. Chekol, C.C. Sun (2012)
• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)

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