Mesothelioma of the testis and nephrotic syndrome: a case report

Our plain-English summary of Mesothelioma of the testis and nephrotic syndrome: a case report, by J. Bacchetta, D. Ranchère, F. Dijoud, et al (Journal of Medical Case Reports, 2009).

The study

• Authors: J. Bacchetta, D. Ranchère, F. Dijoud, J.P. Droz
• Journal: Journal of Medical Case Reports
• Published: 2009;3:7248
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Paraneoplastic glomerulopathies are rare manifestations of neoplastic disease to be distinguished from iatrogenic renal damage. Solid tumors are preferentially associated with membranous nephropathy, whereas Hodgkin's lymphomas are associated with minimal change disease.

Case Presentation: We report a 63-year-old Caucasian male diagnosed with a mesothelioma of the tunica vaginalis testis who, secondary to this, also presented with a nephrotic syndrome due to minimal change disease. In the present case, the paraneoplastic etiology of the nephrotic syndrome can be discussed on four unusual elements: minimal change lesions were found; the glomerulopathy was very sensitive to corticosteroids; the nephrotic syndrome occurred 11 months after the diagnosis of the primary malignancy, but concomitantly with the recurrence; and the nephrotic syndrome did not decrease with tumor control and did not recur when the mesothelioma escaped treatment. No other etiologies could nevertheless explain this phenomenon.

Conclusion: Paraneoplastic nephrotic syndrome is often associated with membranous nephropathy in patients with solid tumors, especially in patients with lung and gastrointestinal tract neoplasia. The management of these patients is associated with a symptomatic treatment such as sodium and water restriction, diuretics and ACE inhibitors and a prophylaxis of specific complications of nephrotic syndrome including thromboembolism, infections and lipid abnormalities. Treatment of neoplasia must be undertaken rapidly, treatments must be regularly analyzed and drugs binding to albumin may be used with precaution.

In plain English

This article was a case report about one man. A 63-year-old Caucasian man was diagnosed in September 2002 with malignant mesothelioma of the tunica vaginalis testis, the lining around the testis, which was removed by surgery. The authors reported that no exposure to asbestos was found. He had smoked for 30 years, until 1994. In August 2003 he developed swelling. Tests showed nephrotic syndrome, a kidney disorder with heavy protein loss in the urine (9 g per 24 hours). A kidney biopsy in October 2003 showed minimal change disease. Prednisolone, a steroid, cleared the protein loss by December 2003, while the cancer spread to lymph nodes at the back of the abdomen. The nephrotic syndrome returned 10 days after surgery on those lymph nodes and was treated again. After chemotherapy and radiotherapy, he died of disease progression in March 2005. The authors believed this was the first report of this tumor together with nephrotic syndrome. They noted that the kidney disease did not follow the pattern usual for kidney disease linked to a cancer, but that no other cause was found.

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), with a brief literature search in the discussion
• Who was studied: One 63-year-old Caucasian man treated in Lyon, France, diagnosed in September 2002 and followed until his death in March 2005
• Exposure: No asbestos exposure was found at the occupational medicine clinic. The patient had a 30-year history of tobacco use, until 1994.
• Main results:
  • The tumor was a tubulopapillary, malignant, well differentiated mesothelioma of the tunica vaginalis testis.
  • In 2003 the patient had heavy protein loss in the urine (9 g per 24 hours) and low serum albumin (9.7 g/l), with normal serum creatinine.
  • A kidney biopsy in October 2003 showed minimal change disease.
  • The proteinuria disappeared with prednisolone by December 2003, while the mesothelioma progressed in the retroperitoneal lymph nodes.
  • The nephrotic syndrome recurred 10 days after retroperitoneal lymph node dissection.
  • The nephrotic syndrome did not improve with tumor control and did not return when the mesothelioma escaped treatment.
  • The patient died of disease progression in March 2005.
  • The authors believed this was the first reported case of tunica vaginalis mesothelioma with nephrotic syndrome.
• The authors' conclusion: The authors concluded that the minimal change nephropathy was "a casual event in the history of a very rare tumor." They added that a person with a known cancer who develops nephrotic syndrome should have a kidney biopsy if their general condition allows.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Etiology.

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