Primary Malignant Mesothelioma of the Tunica Vaginalis: A Case Report and Review of the Literature

Our plain-English summary of Primary Malignant Mesothelioma of the Tunica Vaginalis: A Case Report and Review of the Literature, by A. Elmadani, A. Farag, Z. Al-Qassim, et al (Curēus, 2025).

The study

• Authors: A. Elmadani, A. Farag, Z. Al-Qassim, R. England
• Journal: Curēus
• Published: 2025;17(10):e94081
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Primary malignant mesothelioma of the tunica vaginalis is an extremely rare neoplasm, and its diagnosis is often unclear initially due to its nonspecific presentation. We present the case of an 87-year-old gentleman who presented with a left-sided hydrocele that increased in size over seven months, with no associated history of asbestos exposure. On initial ultrasound, he had a benign appearing hydrocele and proceeded to hydrocelectomy, where suspicious lesions were noticed and sent for histopathology. A subsequent radical inguinal orchiectomy was performed. Histopathologic examination revealed malignant mesothelioma, which was positive for calretinin, Wilm's Tumour 1 (WT-1), AE1/AE3, and D2-40 immunohistochemically, from both operations. On postoperative staging, no metastases were seen, and the patient has been disease-free on follow-up after six months. This case illustrates the challenges in reaching the diagnosis of malignant mesothelioma of the tunica vaginalis and emphasizes the importance of timely surgical intervention in the form of radical orchidectomy and histological examination of any uncommon scrotal mass. Ongoing case reporting is needed to guide management, as there are no standard guidelines due to the limited number of reported cases.

Copyright © 2025, Elmadani et al.

In plain English

This article was a case report from a hospital urology department in the United Kingdom, together with a discussion of earlier published work. It described an 87-year-old man whose left-sided hydrocele (a fluid collection around the testicle) had gradually grown larger over seven months. The patient reported no history of asbestos exposure. An ultrasound scan showed a large hydrocele with no worrying features. During surgery to repair it, however, the surgeons found numerous small solid and cystic masses on the inner surface of the hydrocele sac (the tunica vaginalis). Examination of the removed sac under the microscope confirmed an epithelioid malignant mesothelioma of the tunica vaginalis, and staining tests supported this diagnosis. The patient then had the testicle removed through the groin (radical inguinal orchidectomy). A staging CT scan showed no spread of the tumour. At six months, ultrasound showed no return of the tumour and CT showed no spread. The authors concluded that the case showed the value of routinely examining tissue from atypical or recurrent hydroceles.

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) with a narrative discussion of published literature
• Who was studied: One 87-year-old man with a gradually enlarging left-sided hydrocele, referred to the authors' hospital (Urology, Kettering General Hospital NHS Trust, United Kingdom); dates of care not given
• Exposure: The patient reported no history of asbestos exposure; no other exposure was studied
• Main results:
  • Before surgery, scrotal ultrasound in the patient showed a large left-sided hydrocele with no sinister features
  • During hydrocele repair, numerous small solid and cystic masses were found on the inner surface of the hydrocele sac (tunica vaginalis)
  • Histopathology of the hydrocele sac confirmed epithelioid malignant mesothelioma of the tunica vaginalis
  • In the patient's tumour, immunohistochemical staining was positive for calretinin, WT-1, AE1/AE3 and D2-40, and negative for CEA, BER-EP4, CK5/6 and CK20
  • After radical inguinal orchidectomy, a staging CT scan showed no evidence of metastasis
  • At six-month follow-up, scrotal ultrasound showed no local recurrence and CT showed no metastasis
• The authors' conclusion: The authors concluded that the case emphasizes the diagnostic usefulness of routine histological examination of atypical or recurrent hydroceles, and the key role of immunohistochemistry in establishing mesothelial origin and excluding mimics

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Tunica Vaginalis, Neoplasm, Hydrocele, Asbestos Exposure, Ultrasound, Hydrocelectomy, Histopathology.

Related studies

• Malignant mesothelioma of the tunica vaginalis. A clinicopathologic analysis of 11 cases with review of the literature — M.A. Jones, R.H. Young, et al. (1995)
• Malignant mesothelioma of the tunica vaginalis testis: a rare case and review of literature — M. Drevinskaite, A. Patasius, et al. (2020)
• Malignant mesothelioma of the tunica vaginalis testis: a case report and literature review — J.L. Chen, Y.H. Hsu (2009)
• Mesothelioma of tunica vaginalis of "uncertain malignant potential" - an evolving concept: case report and review of the literature — K. Trpkov, R. Barr, et al. (2011)
• 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. Report of a case without risk factors and review of the literature — A. García de Jalón, P. Gil, et al. (2003)

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