Benign cystic mesothelioma of the tunica vaginalis

Benign multicystic mesothelioma arising from the tunica vaginalis

Benign multicystic mesothelioma is an extremely rare neoplasm usually arising from the visceral mesothelium of the peritoneal cavity typically presenting in young to middle-aged women. It has been deemed an indolent tumour with a possible heritable nature, but also a possible reactive neoplasm secondary to trauma. Diagnosis relies on identifying characteristic histology of cysts separated by loose connective tissue stroma and lined by pale, flat or cuboidal mesothelial cells. A 74-year-old male presented with a painless, enlarging scrotal swelling thought to be either an epididymal cyst or hydrocele. He underwent radical orchiectomy and benign multicystic mesothelioma of the tunica vaginalis was characterized on macroscopy and microscopic examination. The potential for malignant transformation of these tumours has not been demonstrated, but they are known to recur. This infrequent presentation of a rare and poorly understood tumour with description of histologic findings may allow for improved diagnosis in other cases.

Benign multicystic mesothelioma and peritoneal inclusion cysts: are they the same clinical and histopathological entities? A systematic review to find an evidence-based management

PURPOSE

Peritoneal mesothelial cysts (PMC) are a clinical dilemma because of their true pathogenic nature. Many definitions have been associated with PMC, including "benign multicystic mesothelioma", "cystic mesothelioma", "multilocular peritoneal inclusion cysts", ''inflammatory cysts of the peritoneum" or "postoperative peritoneal cyst".

METHODS

We herein performed a systematic review of the literature focusing on clinical and histopathological aspects of PMC, diagnosis, and therapies. Moreover, we described our experience with a case of PMC in a young female.

RESULTS

Since there is often a history of prior surgery or inflammatory disease, most authors consider PMC of reactive origin. However, in some cases they occur without any documentable signs of disease or injury. A variety of clinical findings can complicate the preoperative assessment and a multitude of histological pictures may potentially lead to a misdiagnosis. The absence of a uniform treatment strategy and lack of long-term follow-up often hinder the accurate definition leading to unnecessary or unnecessarily aggressive therapy.

CONCLUSIONS

PMC are more common than had previously been thought. Most authors consider them non-neoplastic; thus the designation of "peritoneal inclusion cyst" is preferable. The term "mesothelioma" should be used only in cases of histological evidences of atypia. The high rates of recurrence suggest that the goal of treatment should not be necessarily complete eradication, but symptomatic relief through individualized treatment. This is a topic of particular importance, especially in young female where recurrence rates could be lower than those reported in adults and where an improperly aggressive treatment could have repercussions on fertility.

Benign Multicystic Peritoneal Mesothelioma Associated with Hydronephrosis and Colovesical Fistula Formation: Report of a Case

Mesotheliomas usually arise from the pleura and are malignant. We report an unusual case of benign peritoneal mesothelioma presenting in a 59-year-old woman. The disease resulted in bilateral hydronephrosis, colovesical fistula formation, recurrent small bowel obstruction and chronic abdominal pain. To date only a handful of cases have been reported and to the best of our knowledge, none has been so aggressive.

Torsed appendix epididymis in an adult: misdiagnosis as tumor of tunica vaginalis on sonography

We report the sonographic findings in a case of torsed appendix epididymis that occurred in an adult, which was misdiagnosed as a tunica vaginalis tumor such as cystic mesothelioma. Scrotal gray-scale sonography revealed an ovoid-shaped, heterogeneously hypoechoic mass with multiple tiny cystic foci and thick septa in the sac of the right tunica vaginalis, which abuts to the right epididymal head. Color Doppler sonography showed no blood flow within the mass. Pathological examination revealed torsion of the appendix epididymis.

Multilocular mesothelial proliferation involving the skin of the umbilicus

Multilocular mesothelial proliferation (MMP) is a rare lesion that mainly arises from the peritoneal mesothelium. Most often, it occurs in women of reproductive age, with a history of abdominal surgery, endometriosis, or pelvic inflammatory disease. We describe an unusual case of a 73-year-old woman affected by a large MMP, which involved the skin and presented clinically as a cutaneous mass. To the best of our knowledge, MMP involving the umbilicus has never been reported in a peer-reviewed literature.

Benign cystic mesothelioma: a rare cause for scrotal swelling

Benign cystic mesothelioma of the tunica vaginalis is a rare occurrence. It usually presents with painless gradual swelling in the scrotum. These types of benign mesotheliomas typically occur in the peritoneum and usually affect young to middle-aged patients. We present in this case an unusual case of benign cystic mesothelioma of the tunica vaginalis in a 77-year-old male patient.

Rare Tumors of the Testis and Mesothelial Proliferation in the Tunica Vaginalis

An increasing number of rare testicular tumors have been recognized in the recent years with a wide and heterogeneous spectrum of morphologies. The utility of ancillary studies, including immunohistochemistry, is often limited and is important for the pathologists to be aware of these entities, because they require a comprehensive pathological and clinical approach for an appropriate treatment.

Cystic peritoneal mesothelioma: report of a case

Benign multicystic peritoneal mesothelioma (BMPM) is a rare disease with good short-term prognosis and rare malignant transformation. However, its biological significance remains unexplained. A neoplastic origin is considered by many authors to require a surgical excision, based on the high recurrence and progressive growth rate of the tumors. However, alternative or integrative treatment options have also been proposed. A 45-year-old woman presented to our unit with a history of occasional discomfort and pain in the left hip. On physical examination, we noticed a tough-elastic, fixed mass located in the iliac fossa. Computed tomography scan detected a mass with multiseptated cystic-like areas. Due to the similarity of these findings to a primitive sarcomatous tumor of the retroperitoneum, an arteriographic study was also performed. The patient underwent en bloc resection of the mass, including a segment of the sigmoid colon. The final pathologic diagnosis was cystic mesothelioma. Further studies are needed to better understand the etiology and pathogenesis of this rare disease, and to define a more tailored treatment plan.

Benign and Malignant Neoplasms of the Testis and Paratesticular Tissue

Benign and malignant tumors of the testes and paratesticular tissues present an interesting spectrum of diagnostic entities often encountered in routine surgical pathology practice. Germ cell tumors are the most common tumors of the testes and, despite a rising incidence, have excellent prognosis because of their radiosensitivity and/or effective chemotherapeutic agents. The proper classification of these tumors aids in the choice of appropriate treatment options. This article reviews benign and malignant neoplastic entities of the testes and paratesticular tissues and illustrates the classic pathologic characteristics. The differential diagnosis, along with ancillary studies, clinical significance, and presentation are discussed also.

Benign multicystic peritoneal mesothelioma: A case report and review of the literature

Benign multicystic peritoneal mesothelioma (BMPM) is a rare tumor that occurs mainly in women in their reproductive age. The pathogenesis of BMPM is unclear and a controversy regarding its neoplastic and reactive nature exists.

The biological behavior of BMPM is characterized by its slowly progressive process and high rate of recurrence after surgical resection. In addition this lesion does not present a strong tendency to transform into malignancy. Today approximately 130 cases have been reported.

We here report a 62-year-old woman who had diffuse abdominal pain, nausea and vomiting. Physical examination revealed a painful mass in her upper abdomen. She reported a mild dehydration, but the vital signs were normal. Peristaltic rushes, gurgles and high-pitched tinkles were audible. Upright plain abdominal film revealed small bowel loops with air-fluid levels. She was diagnosed having an incarcerated incisional hernia that resulted in intestinal obstruction. The patient underwent surgery during which a cystic mass of the right ovary measuring 6 cm x 5 cm x 4 cm, four small cysts of the small bowel (1 cm in diameter) and a cyst at the retroperitoneum measuring 11 cm x 10 cm x 3 cm were found. Complete resection of the lesion was performed. The patient had an uneventful recovery and had no recurrence two years after surgery.

Nonpleural mesotheliomas: mesothelioma of the peritoneum, tunica vaginalis, and pericardium

Mesotheliomas are tumors that arise from the mesothelial cells of the pleura, peritoneum, pericardium, or tunica vaginalis. Although the number of new mesothelioma cases diagnosed each year in the United States seems to be leveling off or decreasing, several other countries are projected to have continued increased incidence of mesothelioma over the next several years. Of the approximately 2500 new cases of mesothelioma in the United States each year, most are pleural mesotheliomas. The peritoneum is the second most common site of mesothelioma development and accounts for approximately 10% to 20% of all mesotheliomas. Mesotheliomas that involve the pericardium or originate from the tunica vaginalis are rare tumors. Given the rarity of these tumors, it is difficult to obtain precise information regarding their incidence, natural history, and optimal management.

Selected other problematic testicular and paratesticular lesions: rete testis neoplasms and pseudotumors, mesothelial lesions and secondary tumors

The proximity and, in some instances, communication between several structures in the testis and paratestis (rete testis, epididymis, mesothelium, vestigial epithelium and paratesticular soft tissue) result in a plethora of interesting tumors and tumor-like lesions that together pose a formidable diagnostic challenge both because of their morphologic overlap and rarity. The occasional spread of tumors primarily at other sites to this region adds to the potential problem encountered. This review provides an overview of the pathology of nonmesenchymal paratesticular neoplasms and pseudotumors with a focus on the approach to tubulopapillary neoplasms for which diagnostic considerations may include carcinoma of the rete testis, malignant mesothelioma, ovarian-type epithelial tumors, epididymal carcinoma and metastatic carcinomas. The cornerstone of accurate characterization of these lesions is still a comprehensive, traditional clinicopathologic approach, clinical history (of another primary), gross examination (location) and routine light microscopy, but judicious incorporation of contemporary immunohistochemical markers may aid or in some instances be crucial in resolving the problems encountered.

Malignant transformation of "benign" cystic mesothelioma of the peritoneum

BACKGROUND AND OBJECTIVES

Peritoneal mesothelioma is being diagnosed with greater accuracy as a result of immunocytochemical analysis. The histological type of peritoneal mesothelioma has a great influence on the natural history of the disease. Benign cystic mesothelioma is a definite clinical entity; however, the absence of a uniform approach to treatment and a lack of long-term follow-up of patients seriously hinders an accurate assessment of the disease process.

METHODS

The medical history of a patient with a diagnosis of benign peritoneal cystic mesothelioma followed for 10 years is presented. The medical literature of this disease is reviewed.

RESULTS

The patient was a 36-year-old woman initially diagnosed with benign cystic peritoneal mesothelioma; however, after six surgical procedures with the aim of reducing the volume of intraperitoneal fluid and cysts, the disease developed into an aggressive, diffuse malignant mesothelioma. Involvement of abdominal incisions, invasion of lymph nodes, and invasion of the viscera occurred.

CONCLUSIONS

Peritoneal cystic mesothelioma is a disease in need of careful longitudinal studies in order to better define the clinical course of these patients. This case report along with a literature review suggests caution in the assessment of cystic mesothelioma as a benign process. This patient had a clear malignant transformation of benign cystic mesothelioma to an invasive and potentially lethal process.