Malignant mesothelioma of the tunica vaginalis testis: A rare cause of hydrocele

Our plain-English summary of Malignant mesothelioma of the tunica vaginalis testis: A rare cause of hydrocele, by M. de Sá Barrêto Callou Peixoto, M.K. Bernardo Soares, B.B. Libânio, et al (Urology Case Reports, 2022).

The study

• Authors: M. de Sá Barrêto Callou Peixoto, M.K. Bernardo Soares, B.B. Libânio, K.S. Albuquerque, C.E. Bacchi
• Journal: Urology Case Reports
• Published: 2022;43:102048
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesotheliomas of the tunica vaginalis testis are very uncommon tumors, with rare cases published in the literature. This report demonstrates a case in with such a tumor was diagnosed in a 50-year-old man who presented to the emergency room with mild, acute scrotal pain and swelling, without previously known scrotal pathology. It is noted that sonographers should be aware of the typical characteristics that allow for suspecting malignancy in scrotal sonography performed in the emergency setting; this was particularly important in this case. Surgical pathology analysis of the right radical orchiectomy specimen confirmed the diagnosis.

© 2022 The Authors. Published by Elsevier Inc.

In plain English

This case report from São Paulo, Brazil, described one patient. A 50-year-old man went to an emergency room with slightly painful swelling on the right side of the scrotum. It had lasted one month and was suspected to be a hydrocele (fluid around the testis). He had a history of smoking and of a bladder inverted papilloma treated three years earlier. Ultrasound showed a 2.1 cm solid lesion with blood flow on the head of the right epididymis, with a hydrocele and a thickened scrotal lining. At surgery, doctors found a nodule and implants on the tunica vaginalis, and they removed the right testis. Tissue examination and immunohistochemistry supported a diagnosis of malignant epithelioid mesothelioma. No metastases were found at staging or after six months of follow-up. The article did not say whether the patient had been exposed to asbestos. The authors wrote that asbestos is thought to be a risk factor, but that the association is not clear, "as in our case." They concluded that radiologists should know the ultrasound signs of malignancy so patients can be referred for treatment in time.

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 50-year-old man seen at an emergency room in São Paulo, Brazil, with right scrotal swelling. He had a history of smoking and of a bladder inverted papilloma treated three years earlier.
• Exposure: The article does not say whether this patient was exposed to asbestos. The authors mention asbestos only as a suspected risk factor for mesothelioma and say that the association is not clear, as in their case.
• Main results:
  • Scrotal ultrasound showed a 2.1 cm solid lesion on the head of the right epididymis, with blood flow on color Doppler, a hydrocele on the same side, and a thickened inner lining of the scrotal wall.
  • During surgery, an ill-defined nodule on the epididymal head and implants on the tunica vaginalis were found. A frozen-section biopsy taken during the operation was indeterminate, so the surgeons performed a radical right orchiectomy (removal of the right testis).
  • The tumor cells expressed cytokeratin, WT-1, calretenin (spelled this way in the article) and podoplanin, supporting a diagnosis of malignant epithelioid mesothelioma. There was no infiltration of the spermatic cord.
  • Staging found no metastases, and there was no recurrence or metastasis after six months of follow-up.
• The authors' conclusion: The authors concluded that some scrotal tumors first appear as a hydrocele and that ultrasound is usually the imaging method of choice. They said radiologists should be familiar with typical malignant features so that patients can be referred for treatment in time.

Topics

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

Related studies

• Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology — S.C. Gupta, A.K. Gupta, et al. (1998)
• Malignant Epithelioid Mesothelioma of the Tunica Vaginalis Testis Presenting as Hydrocele in a Kidney Transplant Recipient — B.M. Behers, C.W. Guske, et al. (2024)
• When a hydrocele is more than a hydrocele: Warning symptoms and signs of malignant mesothelioma of the tunica vaginalis testis — J. Cornfield, M. Lee, et al. (2026)
• Mesothelioma of the Tunica Vaginalis Testis Initially Treated as Hydrocele: A Case Report — J.I. Hori, S. Yamaguchi, et al. (2026)
• Malignant mesothelioma of the tunica vaginalis testis initially misdiagnosed as a benign testicular hydrocele: a case report — C. Zhang, H. Su, et al. (2026)
• 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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