Retroperitoneal lymph node dissection in malignant mesothelioma of tunica vaginalis testis

The necessity of a more aggressive initial surgical treatment in patients with mesothelioma of the testicular tunica vaginalis

Mesothelioma of the tunica vaginalis of the testis (MTVM) is a rare tumor encountering for less than 1% of mesothelioma. Patients suffering from these tumors have poor survival due to local and distant metastasis despite treatment. Actually, no specific treatment recommendations exist for this tumor, yet radical orchidectomy is the gold standard in limited disease. We herein report the case of a 71 patient with MTVM who underwent radical orchidectomy without inguinal lymph node dissection and recurred 2 years later with metastasis in pelvic and mediastinal lymph nodes. Despite systemic chemotherapy combining pemetrexed, bevacizumab and Cisplatinum, the disease relapsed eight months later with multiple metastatic lung nodules leading to a treatment shift. We believe that systematic inguinal-iliac lymph node resection should be included in the initial treatment of this tumor.

Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register

BACKGROUND

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare disease with a poor prognosis. The diagnosis and management of these lesions are often difficult for pathologists, surgeons, oncologists and occupational physicians. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy except orchidectomy.

METHODS

A systematic literature review was conducted among the articles published in the English literature on primary MMTVT. Moreover four cases from the Apulia mesothelioma register are reported here.

RESULTS

Two hundred eighty-nine cases of MMTVT have been reported from 1943 to 2018. Overall asbestos exposure has been investigated only for 58% of all cases reported in this review, while in 41.8% this data are not available. Noteworthy is the fact that in many reports there is not an anamnestic reconstruction of any asbestos exposure. A history of direct occupational, environmental or familial asbestos exposure is found in 27.6% of the cases. The four cases from the Apulia mesothelioma register are all with ascertained occupational exposure to asbestos.

CONCLUSIONS

The true incidence of asbestos exposure in MMTVT is underestimated because of insufficient information reported in older literature. To establish a broad consensus on the causal relationship between asbestos and MMTVT in the scientific community its necessary to analyze the same variables in the epidemiological studies. In general it should be recommended that a positive history of exposure to asbestos or to asbestos-containing materials are at risk for the development of a MMTVT and should be monitored.

An unusual case of paratesticular mesothelioma on the site of previously excised epididymal adenomatoid tumour

INTRODUCTION

Malignant paratesticular tumours are rare. We report a case of paratesticular malignant mesothelioma in a patient who had excision of an adenomatoid tumour on the same site in 2 occasions previously.

PRESENTATION OF CASE

A middle aged man who had an adenomatoid tumour excised from his left hemiscrotum fifteen years previously was referred with a suspicious left epididymal lump. This was followed up sonographically for 2 years until it showed signs of enlargement and testicular invasion; it was then managed with radical orchidectomy. The histology showed paratesticular epithelioid malignant mesothelioma. The patient was referred to the Oncologists for further management.

DISCUSSION

Paratesticular tumours are commonly benign. Scrotal ultrasonography is the preferred diagnostic imaging method. Paratesticular malignant mesotheliomas are very rare and appear to have poor prognosis. The optimal adjuvant treatment post radical orchidectomy is not established yet. In our case there is suggestion of possible malignant transformation from previous adenomatoid tumour.

CONCLUSION

In recurrent paratesticular tumours the clinicians should question the possibility of malignant transformation and manage these cases accordingly.

Malignant mesothelioma of the tunica vaginalis: presenting with intermittent scrotal pain and hydrocele

Paratesticular mesotheliomas are very rare tumors. In this paper, we present the management of a 38-year-old male patient with paratesticular malignant mesothelioma who was initially misdiagnosed and treated as recurrent epididymitis. After the final pathology report defining paratesticular mesothelioma during scrotal exploration, he underwent radical orchiectomy and hemiscrotal excision as a complementary, secondary procedure. His metastatic workup did not show any dissemination. Therefore, he did not receive any adjuvant treatment and remained disease-free for more than 2 years.

Hydroceles: Disturbing Discoveries During Routine Repair

Hydroceles are a common presenting complaint to the urological surgeon. They are known to harbour malignancy in a small percentage of cases. We report a case of malignant mesothelioma of the tunica vaginalis and a case of isolated lymphoma of the spermatic cord, both presenting during routine hydrocele repair. These are both rare diagnoses with a handful of reported cases worldwide. The literature of both these pathological entities is reviewed.

[Paratesticular malignant mesothelioma. Report of a new case]

Malignant mesothelioma of the tunica vaginalis is a rare and aggressive tumor. It appears that surgery have a high value in the treatment. We report a case of malignant mesothelioma of the tunica vaginalis in 65 years old patient and a review of the literature is presented.

Malignant mesothelioma of the tunica vaginalis testis: review of the literature and assessment of prognostic parameters

BACKGROUND

Only 73 cases of malignant mesothelioma of the tunica vaginalis testis have been reported in the last 30 years. Although these tumors were most often seen in patients between ages 55 and 75 years, 10% of the patients were younger than 25 years. Because prognostic parameters have not yet been reported, the authors present another case of a male age 14 years and a review of the available literature, which they conducted to determine prognostic parameters.

METHODS

The medical literature about malignant mesothelioma of the tunica vaginalis testis was reviewed. For the determination of prognostic parameters, a univariate and multivariate Cox regression model was used to assess the relevance of the patient's age, history of asbestos exposure, tumor histology, primary therapeutic approach, and presence of metastatic disease to survival.

RESULTS

Previous exposure to asbestos or asbestos-containing materials must be considered a risk factor for the development of malignant mesothelioma. The major difficulty in managing patients with malignant mesothelioma of the tunica vaginalis testis was determining an accurate preoperative diagnosis, which was reported in only two cases. Due to the lack of characteristic symptoms, 97.3% of the cases were diagnosed intraoperatively. Of patients who underwent local resection of the hydrocele wall, 35.7% experienced local tumor recurrence, as compared with 10.5% after scrotal orchiectomy and 11.5% after inguinal orchiectomy. Therefore, radical orchiectomy should be the first-line therapy. The median survival of the patients was 23 months, which decreased to 14 months in cases of recurrence. The overall recurrence rate (local and disseminated) was 52.5%. More than 60% of recurrences developed within the first 2 years of the follow-up. In some cases of disseminated mesothelioma, adjuvant chemotherapy or radiotherapy was given. Although reports on adjuvant treatments were limited, radiotherapy appeared to be more effective than chemotherapy. However, 37.9% died of disease progression. Assessment of prognostic parameters revealed a significant correlation of patient's age with survival (P < 0.01), with a better outcome for younger patients and a worse disease course for patients with primary disseminated disease (P < 0.05) in univariate analysis. A multivariate Cox regression model of prognostic parameters concerning survival did not yield statistically significant results.

CONCLUSIONS

Malignant mesotheliomas of the tunica vaginalis testis rarely occur, but the possibility should be considered for all age groups. Univariate analysis determined that a patient's age and the presence of primary disseminated disease were prognostic parameters related to survival. Due to the invasive potential of this disease and the risk of tumor recurrence, radical orchiectomy and close follow-up are strongly recommended.

Pre-operative diagnosis of malignant mesothelioma of tunica vaginalis testis by hydrocele fluid cytology

Malignant mesothelioma of tunica vaginalis testis is a rare tumour usually associated with hydrocele. Until now only one case has been documented, where a pre-operative diagnosis was made by cytological examination of hydrocele fluid. We report one more case with pre-operative diagnosis using hydrocele fluid cytology.

Case report: malignant mesothelioma of tunica vaginalis testis presenting with spinal metastasis--report of two cases

Malignant mesotheliomas of tunica vaginalis testis (TVT) are rare tumours with a tendency to disseminate by lymphatic and haematogenous routes. Osseous metastasis is extremely uncommon. We report two cases of malignant mesothelioma of TVT presenting with spinal metastasis.

Malignant mesothelioma of the tunica vaginalis testis diagnosed by aspiration cytology--a case report with review of literature

A case of malignant mesothelioma of the tunica vaginalis testis diagnosed by preoperative cytology of hydrocele fluid is reported. In our view this is only the second case diagnosed by preoperative cytology. The unique feature of this case, the characteristic ultrasound appearance, was recognized and confirmation by aspiration cytology led directly to radical orchiectomy, thus avoiding hydrocelectomy, hemiscrotectomy and possible local recurrence. Aetiopathogenesis and management options of this rare tumour are discussed, with a review of the literature.

Combined therapy in a case of malignant mesothelioma of the tunica vaginalis testis

Malignant mesothelioma of the tunica vaginalis testis is exceedingly rare. A new case mimicking hydrocele in a 47-year-old man is here reported. Clinical staging revealed scrotal cutaneous and funicular tumor invasion together with retroperitoneal adenopathies. Once visceral dissemination was ruled out, radical orchiectomy, left hemiscrotectomy and modified retroperitoneal lymph node dissection were performed. Adjuvant systemic chemotherapy and radiation were also administered. Histologically, an epithelial neoplasm with papillary pattern was evidenced. CAM 5.2 cytokeratin was positive in proliferating cells, but carcinoembryonic and Leu M1 antigens gave negative results. Three years later the patient is free of disease.

A new case of malignant mesothelioma of the tunica vaginalis testis. Immunohistochemistry in comparison with an adenomatoid tumor of the testis

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor with 41 previously reported cases. The histological and immunohistological features of a new case in an 80-year-old patient are described and compared with an adenomatoid tumor of the tunica vaginalis testis, which is considered to be the benign variant of malignant mesothelioma. Both tumors revealed strong cytoplasmic staining for a panepithelial antibody (Lu-5) and membranous staining for BMA-120 (a mesothelial/endothelial cell marker) but yielded negative staining results with the endothelial cell markers QBend-10 (CD 34), Factor VIII-related antigen (vWF) and UEA-1. There was also negative staining for CEA, Ber-EP4, HEA-125 and Blood group related antigens A, B, H. An identical staining pattern was evident in normal and reactive mesothelial cells. Our data support a mesothelial rather than an endothelial derivation of the adenomatoid tumor studied.

Malignant mesothelioma of the tunica vaginalis testis. Report of a case and review of the literature

An autopsy case of malignant mesothelioma of the tunica vaginalis testis in a 60-year-old man is described. The tumor showed widespread metastasis via the lymphatics, leading to the patient's death five years after diagnosis. A review of 38 previously described cases is also presented. The most frequent presenting symptom was hydrocele. When a hydrocele in association with a paratesticular tumor is present, aspiration cytology should be performed first. In most of the cases with a fatal outcome, the tumors metastasized to the retroperitoneal lymph nodes. Once the diagnosis has been made, lymphangiography or CT scan should be done immediately.