Mesothelioma subtypes of the tunica vaginalis: a rare case report and review of histological criteria

Our plain-English summary of Mesothelioma subtypes of the tunica vaginalis: a rare case report and review of histological criteria, by R. Rebecca, M.J. Connor, L. Sun, et al (Journal of Surgical Case Reports, 2019).

The study

• Authors: R. Rebecca, M.J. Connor, L. Sun, T. Johnston, R. Gooch, J. McLoughlin
• Journal: Journal of Surgical Case Reports
• Published: 2019;2019(3):rjz040
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Well-differentiated papillary mesothelioma (WDPM) is a rare histological subtype of mesothelioma arising from the tunica vaginalis. We present a case of a 23-year-old male with a palpable para-testicular lump of 3 years duration. Scrotal exploration revealed a grossly abnormal cystic appearance of his tunica vaginalis. An excision biopsy confirmed WDPM of the tunica vaginalis. The three subtypes of mesothelial tumours of the tunica vaginalis are described by their distinct histological features, tumour growth and reported prognosis. A summary of immunohistochemistry and the surgical management across the disease spectrum is provided. Recent clarification of the histological criteria of WDPM provides the opportunity for surgeons to offer a limited approach to managing this indolent tumour that mimics malignant mesothelioma. However, the lack of evidence on recurrence and progression rates in WDPM restricts most surgeons to performing a radical orchidectomy, as was performed in this case.

In plain English

This article was a case report of one patient, with a short literature review of the three types of mesothelial tumour of the tunica vaginalis, the membrane around the testis: well-differentiated papillary mesothelioma (WDPM), mesothelioma of uncertain malignant potential, and malignant mesothelioma. The patient was a 23-year-old man with an intermittently painful left scrotal swelling that had slowly grown over 3 years. He had no history of asbestos exposure, scrotal trauma, or family history of mesothelioma. Ultrasound showed a 4 cm cystic structure. A biopsy and staining tests suggested WDPM. After a team discussion, the testis was removed (radical orchidectomy) without complication. The removed tissue confirmed WDPM with clear margins and no features of malignant mesothelioma. A CT scan showed no disease outside the testis, and at 18 months there were no signs of recurrence. The authors concluded that clearer tissue criteria for WDPM give surgeons the chance to offer more limited surgery. They added that a lack of evidence on recurrence and progression keeps most surgeons doing radical surgery.

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 a single patient with a brief narrative review of histological criteria, immunohistochemistry and surgical management of the three mesothelioma subtypes of the tunica vaginalis
• Who was studied: One 23-year-old man with a left scrotal swelling that had enlarged over 3 years. The authors are from a UK hospital urology department (West Suffolk NHS Foundation Trust). No dates are given.
• Exposure: None reported. The patient had no history of asbestos exposure, scrotal trauma or family history of mesothelioma.
• Main results:
  • Ultrasound of the patient showed a 4 cm cystic structure with a mildly thickened wall.
  • In the biopsy, the cuboidal cells stained positive for EMA and focally positive for calretinin. p53 staining was positive, and MIB-1 (Ki-67) staining was present on fewer than 5% of cells. The overall picture suggested WDPM.
  • After a radical orchidectomy, the specimen confirmed clear excision margins, WDPM, and no features of malignant mesothelioma.
  • A post-operative CT scan showed no disease outside the testis, and the patient had no signs of recurrence at 18 months after surgery.
• The authors' conclusion: The authors concluded that clearer histological criteria for WDPM give surgeons the opportunity to offer conservative management. However, the lack of evidence on recurrence and progression rates limits most surgeons to radical surgery. Any change would need intra-operative frozen section and evidence of good long-term outcomes.
• Limitations the authors state:
  • The authors note that evidence on recurrence and progression rates in WDPM is lacking.
  • The authors note that immunohistochemistry of these tumour subtypes is poorly reported in the literature.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Well-Differentiated Papillary Mesothelioma, Histological Subtype, Biopsy, Prognosis, Immunohistochemistry.

Related studies

• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)
• Malignant mesothelioma of tunica vaginalis testis: Report of a very rare case with review of the literature — E. Trenti, S.M. Palermo, et al. (2018)
• Malignant Mesothelioma of the Tunica Vaginalis: A Rare Neoplasm--Case Report and Literature Review — M. Segura-González, J. Urias-Rocha, et al. (2015)
• 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 Tunica Vaginalis Testis: Macroscopic and Microscopic Features of a Very Rare Malignancy — E. Arda, M.G. Arıkan, et al. (2017)
• A rare presentation of malignant mesothelioma of the tunica vaginalis managed with immunotherapy and review of the literature — K. Mishra, S. Siddiquee, et al. (2023)

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