Metastatic Malignant Mesothelioma of the Tunica Vaginalis Testis Treated With Sequential Immunotherapy, Chemotherapy, and Radiotherapy With Prolonged Disease Stabilisation: A Case Report

Our plain-English summary of Metastatic Malignant Mesothelioma of the Tunica Vaginalis Testis Treated With Sequential Immunotherapy, Chemotherapy, and Radiotherapy With Prolonged Disease Stabilisation: A Case Report, by N. Mathiyalagan, S. Khan, A. Pascoe, et al (Curēus, 2026).

The study

• Authors: N. Mathiyalagan, S. Khan, A. Pascoe, M. Chauhan, M.A. Sarwar, W.N. Abuzahra, S. Azad, G. Mohindru
• Journal: Curēus
• Published: 2026;18(8):e114824
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

We report the case of a 77-year-old man with no known history of asbestos exposure who presented with a right-sided hydrocele. Histopathological analysis following hydrocele repair identified epithelioid-type malignant mesothelioma of the tunica vaginalis testis. Staging investigations confirmed disease confined to the hemiscrotum, and definitive management included right inguinal orchidectomy, excision of the spermatic cord to the deep inguinal ring, and wide local excision of the involved scrotal tissue. Initial surveillance imaging showed no recurrence, but nodal metastatic disease subsequently developed. The patient received first-line immunotherapy with ipilimumab and nivolumab but experienced progressive nodal disease. Second-line carboplatin-pemetrexed chemotherapy resulted in a mixed radiological response after three cycles, with para-aortic nodal oligoprogression managed using palliative radiotherapy. Following palliative radiotherapy and three further cycles of carboplatin-pemetrexed chemotherapy, imaging demonstrated a partial radiological response. Further surveillance revealed thoracic and intra-abdominal nodal progression, which was managed with a second course of palliative radiotherapy and was followed by renewed disease stabilisation. Subsequent progression involved pulmonary and intra-abdominal nodal disease, prompting initiation of third-line oral vinorelbine. Imaging demonstrated predominantly stable disease with isolated para-aortic oligoprogression, which was treated with a third course of palliative radiotherapy, after which vinorelbine was resumed. Approximately four years after diagnosis, the patient remained clinically stable, with an Eastern Cooperative Oncology Group (ECOG) performance status of 1, and was awaiting interval imaging to assess radiological disease status. This case illustrates that an individualised sequential treatment strategy incorporating immunotherapy, chemotherapy, and palliative radiotherapy to sites of oligoprogression may be associated with periods of disease control in metastatic malignant mesothelioma of the tunica vaginalis testis.

Copyright © 2026, Mathiyalagan et al.

In plain English

This case report described one 77-year-old man with no known history of asbestos exposure who came to doctors with a right-sided hydrocele. During hydrocele repair the surgeon saw abnormal tissue and took a biopsy. It showed epithelioid-type malignant mesothelioma of the tunica vaginalis, the lining around the testis. Scans showed no spread, and he had the right testis, the spermatic cord and the involved scrotal tissue removed. In Year 2 an enlarging lymph node near the aorta was judged to be metastatic disease, although it was not biopsied. The disease progressed during immunotherapy with ipilimumab and nivolumab. Carboplatin-pemetrexed chemotherapy combined with palliative radiotherapy to lymph nodes was followed by a partial response. After later progression, a second radiotherapy course was followed by stable disease. He then received oral vinorelbine and a third radiotherapy course. After about four years of follow-up he remained clinically stable. The authors concluded that this sequential treatment was associated with periods of disease stabilisation. They added that a single case cannot establish how much each treatment contributed.

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 77-year-old man with ECOG performance status 1 and no significant comorbidities. The authors are based at Nottingham University Hospitals NHS Trust, UK. Dates are given only as Year 1 to Year 5.
• Exposure: No known history of asbestos exposure. The study concerns treatment of the disease, not its cause.
• Main results:
  • A biopsy taken during hydrocele repair confirmed epithelioid-type malignant mesothelioma of the tunica vaginalis, with a predominant tubulopapillary growth pattern.
  • Staging CT showed no lymphadenopathy or distant metastases. He then had right inguinal orchidectomy, excision of the spermatic cord to the deep inguinal ring, and wide local excision of the involved scrotal tissue.
  • A new 9 mm aortocaval lymph node appeared in early Year 2 and grew to 13 mm by mid-Year 2. It was not biopsied, but after multidisciplinary review it was considered consistent with metastatic disease.
  • First-line immunotherapy with ipilimumab and nivolumab was followed by disease progression after four cycles, and it was stopped.
  • Second-line carboplatin-pemetrexed gave a mixed response after three cycles. It was followed by palliative radiotherapy (20 Gy in five fractions) and three more cycles, after which imaging showed a partial response.
  • After progression in early Year 4, a second course of palliative radiotherapy (20 Gy in five fractions) was followed by reduced nodal burden and then stable disease.
  • New lung nodules and worsening abdominal nodes in late Year 4 led to third-line oral vinorelbine. After three cycles, disease was stable overall except for one para-aortic lymph node, which was then treated with a third radiotherapy course (15 Gy in five fractions).
  • No significant vinorelbine-related toxicity and no clinically significant cumulative radiotherapy-related toxicity were observed.
  • At manuscript submission the patient remained clinically stable with ECOG performance status 1 and was awaiting further CT imaging.
• The authors' conclusion: The authors concluded that, over about four years, sequential immune checkpoint inhibition, platinum-pemetrexed chemotherapy and palliative radiotherapy to sites of oligoprogression were associated with periods of overall disease stabilisation. They also concluded that radiotherapy was followed by local disease control at the treated sites.
• Limitations the authors state:
  • A single case cannot establish whether any individual treatment works or define a standard management strategy.
  • The contribution of radiotherapy cannot be separated from the effects of systemic treatment.
  • Response categories came from radiology reports written at the time, not from formally applied RECIST 1.1 criteria.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Immunotherapy, Chemotherapy, Asbestos Exposure, Hydrocele, Epithelioid, Staging.

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• Mesothelioma of the Tunica Vaginalis Testis Initially Treated as Hydrocele: A Case Report — J.I. Hori, S. Yamaguchi, et al. (2026)
• Efficacy of Nivolumab in Chemotherapy-Resistant Mesothelioma of the Tunica Vaginalis Testis: A Case Report — H. Koyanagi, T. Kawahara, et al. (2026)
• Malignant mesothelioma of the tunica vaginalis testis: report of first case with preoperative diagnosis — L. Japko, A.A. Horta, et al. (1982)
• Malignant mesothelioma of the tunica vaginalis testis — K. Antman, S. Cohen, et al. (1984)
• Epidemiology of mesothelioma of the pericardium and tunica vaginalis testis — G. Mezei, E.T. Chang, et al. (2017)

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