Malignant paratesticular mesothelioma

Our plain-English summary of Malignant paratesticular mesothelioma, by L.G. da Fonseca, D.F. Marques, T.K. Takahashi, et al (Autopsy & Case Reports, 2014).

The study

• Authors: L.G. da Fonseca, D.F. Marques, T.K. Takahashi, F.N. Aguiar, J.N. Ravanini, D.F. Saragiotto
• Journal: Autopsy & Case Reports
• Published: 2014;4(1):45-51
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Mesothelioma of the tunica vaginalis testis (MTVT) is a rare tumor that usually affects patients after the sixth decade of life. Exposure to asbestos is a known risk factor. Enlargement of the scrotal volume is the most common initial clinical manifestation, and about 15% of cases present metastasis at diagnosis. The treatment relies on surgical resection while the role of adjuvant chemotherapy and radiotherapy remains unclear. The prognosis for patients is generally poor, with a lethal outcome in 30% over a 24-month period. The authors report a case of a 62-year-old patient with the diagnosis of MTVT without a history of asbestos exposure. After surgical treatment, metastatic disease ensued. Chemotherapy was initiated, but could not be continued due to marked and fast clinical deterioration. The authors call attention to the difficulty of early diagnosis of MTVT due to a nonspecific clinical picture, the lack of action by the patient when the scrotal enlargement was first noticed, and the lack of tumor markers. Delayed diagnosis is definitely related to unfavorable prognosis.

In plain English

This article was a case report from a cancer institute in São Paulo, Brazil, describing one 62-year-old man with malignant mesothelioma of the tunica vaginalis testis, the lining around the testicle. Over 12 months his left testicle had gradually enlarged, and he had lost 5 kg. The report stated that he had no occupation related to asbestos exposure and no family history of cancer. Ultrasound showed a mass measuring 11.6 × 9.5 × 6.8 cm. Blood tumor markers were within reference ranges. Surgeons removed the left testicle, and tissue tests showed a biphasic (epithelioid and sarcomatoid) malignant paratesticular mesothelioma. Three months later scans showed many enlarged lymph nodes in the groin, abdomen and chest, the largest 10 × 6.4 cm, and a few small lung nodules. He received two cycles of pemetrexed and cisplatin, then declined sharply. He was moved to palliative care and died 24 days later. The authors stated they could not find evidence of exposure to known risk factors. They concluded that this tumor should be considered when the scrotum enlarges, regardless of any history of asbestos exposure, and that early diagnosis is of great importance.

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)
• Who was studied: One 62-year-old man seen at the Instituto do Câncer do Estado de São Paulo, Brazil, with progressive enlargement of the left testicle over 12 months and 5 kg of weight loss
• Exposure: No occupational asbestos exposure was reported. He was a former smoker (20 packs/year). The authors could not find evidence of exposure to known risk factors.
• Main results:
  • Ultrasound showed a heterogeneous left testicular mass with cystic areas measuring 11.6 × 9.5 × 6.8 cm
  • Serum tumor markers were within reference values: chorionic gonadotropin below 3 IU/L, alpha-fetoprotein 2.5 ng/mL, lactic dehydrogenase 310 U/L
  • After left inguinal orchiectomy, tissue examination and immunohistochemistry were compatible with biphasic (epithelioid and sarcomatoid) malignant paratesticular mesothelioma
  • Three months after surgery he had an enlarged groin lymph node. CT showed multiple enlarged lymph nodes in the chest, abdomen, pelvis and groin, the largest 10 × 6.4 cm, plus a few non-calcified lung nodules.
  • He received two cycles of pemetrexed and cisplatin. After 20 days he had markedly declined, was referred to exclusive palliative care, and died after 24 days.
• The authors' conclusion: The authors concluded that, although they could not find exposure to known risk factors, the patient's age and presentation fit the reported features of this tumor. They stated it should be considered in any scrotal mass or enlargement, even if first diagnosed as a hydrocele, regardless of asbestos exposure or family cancer history, and that early diagnosis is of great importance.

Topics

Medical terms in this study, explained in our Lexicon: Testicular Mesothelioma, Mesothelioma, Tunica Vaginalis, Metastasis, Surgical Resection, Chemotherapy, Prognosis, Asbestos Exposure.

Related studies

• Adult paratesticular tumours — B. Khoubehi, V. Mishra, et al. (2002)
• Paratesticular mesothelioma. Report of a case with comprehensive review of literature — M. Bisceglia, D.B. Dor, et al. (2010)
• Paratesticular malignant mesothelioma associated with abdominoscrotal hydrocele — A.L. Velasco, J. Ophoven, et al. (1988)
• Paratesticular mesotheliomas — R.E. McDonald, A.L. Sago, et al. (1983)
• Paratesticular papillary mesothelioma — R. Linn, B. Moskovitz, et al. (1988)
• Geographic distribution of incidence of pericardial and paratesticular mesotheliomas in the USA — S.J. Lowry, N.S. Weiss (2016)

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