Timely Surgical Resection Achieved Prolonged Remission in Patients With Malignant Mesothelioma of the Tunica Vaginalis Testis and Retroperitoneal Recurrence

Our plain-English summary of Timely Surgical Resection Achieved Prolonged Remission in Patients With Malignant Mesothelioma of the Tunica Vaginalis Testis and Retroperitoneal Recurrence, by M. Radovanovic, U. Kojic, A. Zubelic, et al (Curēus, 2024).

The study

• Authors: M. Radovanovic, U. Kojic, A. Zubelic, D. Jakulic, Z. Filipovic
• Journal: Curēus
• Published: 2024;16(4):e59052
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare tumor of the testicular sheath. More than 50% of cases initially present as recurrent hydrocele, but there have also been documented cases with hematocele, inguinal hernia, or epididymitis. Due to the non-specific symptoms and signs of the disease, it is almost always diagnosed intra- or postoperatively. The lack of standardized therapy protocols, as well as the lack of evidence supporting systemic chemotherapy, have fueled arguments in favor of the necessity of retroperitoneal lymph node dissection (RPLND) in the treatment of the disease, especially in the case of lymph node metastasis. We present a case of MMTVT achieving prolonged remission after timely and extensive surgical treatment.

Copyright © 2024, Radovanovic et al.

In plain English

This article is a case report from urologists in Belgrade, Serbia, about one 59-year-old man with malignant mesothelioma of the tunica vaginalis testis, a rare tumor of the sheath around the testicle. He came in with a painful, swollen right scrotum and a scrotal hematoma (a collection of blood) after a minor injury. He had a known untreated right-sided hydrocele (fluid around the testicle) of about a year and was on permanent anticoagulant (blood-thinning) therapy. Tumor marker blood tests were normal, but the ultrasound was suspicious. Surgeons removed the right testicle and half of the scrotum, and the tumor was classified as the epithelioid subtype. A CT scan showed no spread, so he was followed with imaging and not given chemotherapy. At 18 months, a magnetic resonance (NMR) scan showed enlarged right iliac lymph nodes. Surgeons removed lymph nodes from the back of the abdomen on both sides, which confirmed recurrence. Twelve months of follow-up showed complete remission. The article does not report whether this man was exposed to asbestos. The authors concluded that the case gives another insight into the possible benefits of timely 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 (single patient)
• Who was studied: One 59-year-old man treated by urologists at hospitals in Belgrade, Serbia (dates of treatment not given). He had a painful right-sided scrotal swelling with a scrotal hematoma after a minor genital injury, a known untreated right hydrocele of about one year, and was on permanent anticoagulant therapy.
• Exposure: The article does not report whether this patient had any asbestos exposure. The asbestos figures it mentions (30-40% of cases) come from other studies, not this patient.
• Main results:
  • In this patient, the tumor markers AFP and bHCG were within reference values, but the ultrasound findings were suspicious, so the right scrotal sac was explored surgically.
  • After radical orchiectomy with right hemiscrotectomy, the tumor was classified as malignant mesothelioma of the tunica vaginalis testis, epithelioid subtype. No lymphadenectomy was done at first because there were no suspicious lymph nodes.
  • Staging CT of the abdomen and pelvis showed no enlarged lymph nodes or spread to other organs. With negative resection margins, the patient was placed on active imaging surveillance without chemotherapy.
  • At 18 months after the first operation, NMR of the abdomen and pelvis showed enlarged lymph nodes in the right iliac region.
  • A full bilateral retroperitoneal lymph node dissection (RPLND) was performed, and pathology confirmed disease recurrence in the lymph nodes.
  • At 12 months of follow-up after the lymph node surgery, the patient was in complete remission and remained under active surveillance.
• The authors' conclusion: The authors concluded that this case gives another insight into the possible benefits of timely surgical resection with RPLND in patients with this tumor and retroperitoneal recurrence. In their view, this achieved prolonged remission while potentially keeping morbidity lower by avoiding chemotherapy and radiotherapy, which they described as often ineffective.
• Limitations the authors state:
  • The authors acknowledged that there is little published evidence for RPLND in this tumor: they stated it is described in fewer than 15 cases, and they chose it despite limited literature data.
  • The authors noted that the available outcome data come from retrospective case reports and small case series, and that larger datasets are needed to define therapy protocols.

Topics

Medical terms in this study, explained in our Lexicon: Surgical Resection, Mesothelioma, Tunica Vaginalis, Hydrocele, Inguinal Hernia, Epididymitis, Chemotherapy, Retroperitoneal Lymph Node Dissection (RPLND).

Related studies

• Retroperitoneal lymph node dissection in malignant mesothelioma of tunica vaginalis testis — J.J. Smith, M.J. Malone, et al. (1990)
• Metastatic Malignant Mesothelioma of the Tunica Vaginalis Testis Treated With Sequential Immunotherapy, Chemotherapy, and Radiotherapy With Prolonged Disease Stabilisation: A Case Report — N. Mathiyalagan, S. Khan, et al. (2026)
• Cutaneous recurrence of malignant mesothelioma of the tunica vaginalis testis: a rare case report — P. Priester, J. Kopecký, et al. (2012)
• Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy — P. Recabal, B. Rosenzweig, et al. (2017)
• Malignant Mesothelioma of the Testes with Retroperitoneal Recurrence and Resection in an 80-Year-Old Male and Review of the Literature — W.C.I. Janes, S. Al-Asaaed, et al. (2023)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)

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