When a hydrocele is more than a hydrocele: Warning symptoms and signs of malignant mesothelioma of the tunica vaginalis testis

Our plain-English summary of When a hydrocele is more than a hydrocele: Warning symptoms and signs of malignant mesothelioma of the tunica vaginalis testis, by J. Cornfield, M. Lee, R. Sharifi (Urology Case Reports, 2026).

The study

• Authors: J. Cornfield, M. Lee, R. Sharifi
• Journal: Urology Case Reports
• Published: 2026;66:103430
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare tumor with no pathognomonic features. It most often presents as a hydrocele. Preoperative assessment, surgical management and prognosis of MMTVT are different than that of a hydrocele. When MMTVT is not suspected and a transcrotal hydrocelectomy is performed, the latter predisposes to tumor cell seeding, increases the risk of tumor recurrence, and decreases the patient's life survival. Therefore, it is prudent for physicians to identify warning symptoms and signs of MMTVT so that they can identify when a hydrocele is more than a hydrocele.

In plain English

This case report describes one man with malignant mesothelioma of the tunica vaginalis testis (MMTVT), a tumor of the lining around the testicle. The 37-year-old came in with severe right testicular pain. He may have been exposed to asbestos during four years of Navy service on an old ship in the Middle East; no fiber type was named. Ultrasound showed a large right hydrocele (a fluid-filled swelling) with internal debris, and he was first treated for epididymitis. Swelling persisted, so a hydrocelectomy was done. The tissue showed low-grade epithelioid MMTVT reaching the cut edge. He then had a hemiscrotectomy, right radical orchiectomy and right inguinal lymph node dissection. All margins and all six lymph nodes were negative. A second opinion found adjuvant chemotherapy unwarranted because he had no metastases and negative margins. Scans over three and a half years showed no recurrence. The authors concluded that MMTVT should be suspected when a hydrocele develops rapidly or is painful, or the scrotum feels thickened, hard, edematous, studded or nodular, and that imaging should precede surgery. Survival and recurrence figures in the discussion come from other published studies.

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 discussion and summary table drawn from published literature
• Who was studied: one 37-year-old man; place and dates of treatment are not stated
• Exposure: possible asbestos exposure during Navy service, stationed on an old ship in the Middle East for four years; no fiber type or dose given. He also smoked socially from 2015, rising to 2-3 cigarettes daily in 2020, and stopped in 2021
• Main results:
  • Initial ultrasound in this patient showed a large right hydrocele with internal debris. He was diagnosed with right epididymitis with a reactive hydrocele.
  • Pathology of the hydrocelectomy specimen showed MMTVT, epithelioid type, involving the cauterized edge of the tunica vaginalis; it was graded grade 1 or low grade
  • PET-CT after the hydrocelectomy showed a small focus of FDG accumulation in the right scrotal region and a smaller focus superolaterally
  • After hemiscrotectomy, right radical orchiectomy and right inguinal lymph node dissection, pathology showed grade 1/low grade epithelioid MMTVT with all margins and all six inguinal lymph nodes negative
  • For this patient, a second opinion confirmed that adjuvant chemotherapy was not warranted given the absence of metastases and negative surgical margins after the radical orchioscrotectomy
  • Scans every three or six months for three and one half years after the second surgery showed no evidence of MMTVT recurrence. A 2 mm lung nodule seen at staging stayed unchanged.
• The authors' conclusion: The authors concluded that MMTVT should be suspected when a hydrocele has developed rapidly, the scrotum feels thickened, hard, edematous, studded or nodular, or the hydrocele is painful. They concluded that scrotal ultrasound, color doppler, CT or PET should be done before surgery so the most appropriate procedure can be chosen.
• Limitations the authors state:
  • Images of the immunostaining slides could not be recovered; only hematoxylin and eosin stains were available for the report

Topics

Medical terms in this study, explained in our Lexicon: Hydrocele, Mesothelioma, Tunica Vaginalis, Prognosis, Hydrocelectomy.

Related studies

• Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology — S.C. Gupta, A.K. Gupta, et al. (1998)
• Malignant mesothelioma of the tunica vaginalis testis: A rare cause of hydrocele — M. de Sá Barrêto Callou Peixoto, M.K. Bernardo Soares, et al. (2022)
• Malignant Epithelioid Mesothelioma of the Tunica Vaginalis Testis Presenting as Hydrocele in a Kidney Transplant Recipient — B.M. Behers, C.W. Guske, et al. (2024)
• Mesothelioma of the Tunica Vaginalis Testis Initially Treated as Hydrocele: A Case Report — J.I. Hori, S. Yamaguchi, et al. (2026)
• Malignant mesothelioma of the tunica vaginalis testis initially misdiagnosed as a benign testicular hydrocele: a case report — C. Zhang, H. Su, et al. (2026)
• 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)

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