Malignant mesothelioma of the tunica vaginalis testis: a malignancy associated with recurrent epididymitis?

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis testis: a malignancy associated with recurrent epididymitis?, by C.H. Yen, C.T. Lee, C.J. Su, et al (World Journal of Surgical Oncology, 2012).

The study

• Authors: C.H. Yen, C.T. Lee, C.J. Su, H.C. Lo
• Journal: World Journal of Surgical Oncology
• Published: 2012;10:238
• Type of article: Case report
• Cited by: 28 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 53-year-old Taiwanese male had several episodes of left epididymitis with hydrocele refractory to antibiotic treatment. Partial epididymectomy plus preventive vasectomy were planned, and, incidentally, an ill-defined nodule was found lying on the tunica vaginalis near the epididymal head. The pathological diagnosis was malignant mesothelioma of the tunica vaginalis testis. Radical orchiectomy with wide excision of the hemi-scrotal wall was performed. So far, there is no evidence of recurrence after more than 3 years of follow-up. Malignant tumor should be considered in the case of recurrent epididymitis refractory to empirically effective antibiotic treatment. Although the nature of this tumor is highly fatal, the malignancy can possibly be cured by early and aggressive surgical treatment.

In plain English

This case report described a 53-year-old man in Taiwan who denied any history of asbestos exposure or scrotal trauma. A recurring painful nodule on his left scrotum was treated with antibiotics as epididymitis (inflammation of the epididymis). Symptoms eased for about a year, then returned and responded poorly to antibiotics. During planned surgery, an ill-defined nodule measuring 2 × 1 × 1 cm was found on the tunica vaginalis, the lining around the testis. It was diagnosed as well-differentiated malignant mesothelioma of the tunica vaginalis testis. A CT scan showed no local invasion or lymph node spread, and the testis and part of the scrotal wall were removed. After more than 3 years he had no sign of recurrence. The authors also tallied 101 cases, including this one, from articles found in a PubMed search covering 1998 to August 2012. The diagnosis suspected before surgery was hydrocele in 50 (49.5%), a suspected testicular tumor in 37 (36.6%), and epididymitis in 3 (3%). The authors concluded that the cancer might mimic epididymitis and proposed a hypothetical link between the two. They also wrote that early, aggressive surgery could potentially cure it.

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 one patient, with a tally of preoperative diagnoses in 101 published cases (including this one) identified through a PubMed search
• Who was studied: One 53-year-old man referred to the Song-Shan Armed Forces General Hospital, Taipei, Taiwan, about 3 years before the 2012 report; plus 101 cases (including this one) from articles found in a PubMed search covering 1998 to August 2012
• Exposure: The patient denied any history of exposure to asbestos or scrotal trauma; the authors discussed recurrent epididymitis as a hypothetical factor
• Main results:
  • In the patient, epididymitis recurred about a year after initial antibiotic treatment, and the second time antibiotics had limited effect
  • During surgery, an ill-defined nodule measuring 2 × 1 × 1 cm was found on the tunica vaginalis near the epididymal head
  • The patient's tumor cells stained positive for cytokeratin and calretinin (spelled 'calretenin' in the article) and negative for CEA, confirming malignant mesothelioma of the tunica vaginalis testis
  • After radical orchiectomy with wide excision of the hemi-scrotal wall, the patient had no evidence of local or distant recurrence after over 3 years of follow-up
  • Among the 101 tallied cases, the preoperative diagnosis was hydrocele in 50 (49.5%), suspicious testicular tumor in 37 (36.6%), inguinal hernia in 6 (5.9%), epididymitis in 3 (3%), spermatocele in 2 (2%), testicular torsion in 2 (2%) and post-traumatic testicular lesion in 1 (1%)
• The authors' conclusion: The authors concluded that malignant mesothelioma of the tunica vaginalis testis might mimic epididymitis. They proposed a hypothetical correlation between epididymitis and this cancer. They wrote that malignancy should be considered in recurrent epididymitis that does not respond to antibiotics, and that early, aggressive surgery could potentially cure the disease.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Epididymitis, Hydrocele, Orchiectomy.

Related studies

• Mesothelioma of the tunica vaginalis testis: a rare malignancy mimicking more common inguino-scrotal masses — P.J. Schure, K.C. van Dalen, et al. (2006)
• Malignant Mesothelioma of the Tunica Vaginalis Testis-A Malignancy Associated With Asbestos Exposure and Trauma: A Case Report and Literature Review — A.A. Baqui, N.A. Boire, et al. (2019)
• 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)
• Mesothelioma of the tunica vaginalis testis — K.J. Butnor, E.N. Pavlisko, et al. (2019)
• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)

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