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.     

Malignant mesothelioma of the tunica vaginalis testis: a case with a predominant sarcomatous component

We present a case of malignant mesothelioma (MM) of the tunica vaginalis testis. A 64-year-old man was referred for an operation on a right hydrocele that later proved to be a tumor during surgery. The tumor was malignant with a biphasic pattern of epithelial and sarcomatous components. The latter component was predominant. Cuboidal or columnar cells formed irregular tubular structures in the epithelial component. In contrast, spindle-shaped or polygonal cells formed intricate structures with stromal connective tissues in the sarcomatous component. Immunohistochemical staining revealed that the tumor was mesothelial in origin and positive for cytokeratin, vimentin, HBME-1 antigen and calretinin. In general, MM occur in the pleura or peritoneum; those originating in the tunica vaginalis testis are very rare and represent less than 5% of all MM. In addition, MM in the tissues usually consist primarily of an epithelial component. According to previous reports tumors with a predominant sarcomatous component are extremely rare. In general, a sarcomatous component predicts poor prognosis and our case does, in fact, deteriorate over time. Our case suggests that despite its low incidence, MM must be considered when a case is diagnosed as hydrocele testicle.     

Malignant mesothelioma of the tunica vaginalis

A case of a malignant mesothelioma of the tunica vaginalis is presented. The patient with an intrascrotal mass was a 32-year-old Japanese male who had no history of asbestos exposure. The tumor was located on the surface of the right testis and was composed of columnar to polygonal cells with glandular and papillary structures. It showed many mitoses and focal invasion of the tunica albuginea. The tumor cells contained alcian blue- and Hale's colloidal iron-positive, hyaluronidase-digestible materials. Immunohistochemical stains for cytokeratin and vimentin were positive, while those for carcinoembryonic antigen, epithelial membrane antigen, Leu-M1, and factor VIII-related antigen were negative. The systemic examinations revealed no other tumors. Based on these findings the tumor was diagnosed as malignant mesothelioma of the tunica vaginalis. The differential diagnosis is discussed under the histologic, histochemical, and immunohistochemical points of view and the previous literature is reviewed.     

Papillary mesothelioma of the tunica vaginalis propria testis

Summary Ultrastructural features of a papillary mesothelioma arising in a hydrocele-sack are reported. The tumour cells presented numerous microvilli, desmosomes, basement membranes and abundant bundles of microfilaments, which all are hallmarks of mesotheliomas. The predominant cell type was the clear epithelial cell, but transitional cells and degenerative forms (foamy cells) were also found. The morphology and differential diagnosis of mesothelial tumours arising in the tunica vaginalis propria testis are discussed.     

Malignant mesothelioma of the tunica vaginalis in a dog

A 12-year-old Scottish terrier had a scrotal mass which was diagnosed as a malignant mesothelioma of the tunica vaginalis. The tumour resulted in a rapidly fatal clinical course with direct extension into the peritoneal cavity via the inguinal canal; there were no haematogenous or lymphatic metastases. This is the first case report of such a tumour in the dog. The histology and differential diagnoses of these tumours and a review of similar tumours in other species and possible causative agents are given.     

Benign papillary mesothelioma of the tunica vaginalis testis

We report a case of benign mesothelioma of the tunica vaginalis testis in a 69-year-old man who presented with a 4-month history of scrotal swelling. A polypoid pedunculated nodule, 1.5 cm in diameter, was found near the head of the right epididymis. Histologically, the tumor exhibited features characteristic of a well-differentiated papillary mesothelioma. The mesothelial origin of this tumor was further supported by immunohistochemical analysis. The tumor cells exhibited nuclear p53 protein accumulation, despite the benign histologic findings and a 3-year uneventful follow-up after resection. A polymerase chain reaction analysis for simian virus 40 DNA was negative. The papillary configuration seen in this tumor is uncommon for this site, inasmuch as benign mesotheliomas of the tunica vaginalis testis usually exhibit an adenomatous pattern. One should be aware of this pattern, and benignity should be mentioned in the pathologic report to prevent overtreatment. In addition, positive p53 immunohistochemical staining should not be taken automatically as evidence for malignancy in this type of lesion.     

Malignant mesothelioma of the tunica vaginalis testis: diagnostic studies and differential diagnosis

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor representing 0.3% to 5% of all malignant mesotheliomas. Gross examination of testicular mesotheliomas typically reveals tumor nodules studding the thickened tunica vaginalis and, in some cases, infiltrating the testicular parenchyma, leading to diagnostic challenges. Microscopically, the tumor is characterized by epithelioid cells arising from the tunica vaginalis with papillary, tubulopapillary, or solid architectural patterns. The papillae are usually lined by a single layer of cells with relatively bland cytologic features. An epithelial cell phenotype admixed with a sarcomatoid pattern has also been described in a few cases. Immunohistochemically, the tumor is usually positive for calretinin, Wilms tumor-1, epithelial membrane antigen, D2-40, thrombomodulin, cytokeratin 7, and cytokeratin 5/6. Electron microscopic studies reveal epithelial cells joined by tight junctions, forming lumina, and displaying long microvilli with length to width ratios often greater than 10. The most important differential diagnostic considerations include florid mesothelial hyperplasia, adenomatoid tumor, carcinoma of the rete testis, and serous papillary tumors. In addition, the various types of testicular germ cell tumors should be considered, including seminomas, embryonal carcinomas, and intratubular germ cell tumors, particularly in tumors with testicular parenchymal involvement. Pleomorphic sarcomas should also be considered, particularly when dealing with the biphasic variant. The prognosis for this entity is grave, with a median survival of 23 months. Aggressive therapy with radical orchiectomy remains the mainstay of treatment.     

Malignant mesothelioma of the tunica vaginalis and epididymis

Malignant mesothelioma of the para-testis is a rare cancer which may be clinically undiagnosed for several years and found incidentally at cut up for presumed benign disease. It has a number of histological presentations to be aware of and pitfalls to avoid. It is important to be able to reliably distinguish para-testicular MM from various other less aggressive entities which have significantly different management strategies. We present a case of epididymis and tunica vaginalis MM that was incidentally diagnosed on histological examination following a hydrocelectomy.     

睾丸鞘膜恶性间皮瘤3例临床病理分析及文献复习

目的探讨睾丸鞘膜恶性间皮瘤(malignant mesothelioma)的临床病理学特征及诊断、鉴别诊断要点。方法对3例睾丸鞘膜恶性间皮瘤进行临床病理学分析、免疫组化EnVision两步法染色及超微结构观察,并结合文献对该病的临床表现、组织形态学特点、免疫表型、超微结构特点和预后进行探讨。结果 3例患者临床症状均为阴囊肿块伴或不伴鞘膜积液,大体观察肿瘤呈结节状,直径0.4～5.0 cm,切面实性或囊实性,灰白,质韧。光镜下见肿瘤细胞形态多样,呈巢状、束状、编织状、实性片状或腺管状排列,瘤细胞胞质空淡或淡红染,核圆形、卵圆形或不规则形,核仁明显,核分裂象可见。免疫表型:瘤细胞均表达CKpan、Calretinin、EMA、vimentin、calponin、CK7、Villin;部分表达CK5/6、WT-1、CEA、SMA、S-100蛋白、CD34、CEA;D2-40、HBME-1、CD30、desmin、CD117和CK20均阴性;Ki-67增殖指数10%～30%。电镜观察细胞表面可见多量细长的微绒毛,细胞间可见细胞间连接,包括桥粒和连接复合体,胞质内见多量细胞丝,包括张力原纤维及一定数量的糖原。结论睾丸鞘膜恶性间皮瘤较罕见,临床诊断较困难。确诊需根据其光镜病理形态特征,辅以免疫组化标记和(或)电镜检查。病理学上应与间皮增生、腺瘤样瘤、睾丸网腺癌、浆液性乳头状肿瘤等鉴别。该肿瘤完全切除后预后较好,以随访为主,可行放、化疗等辅助治疗。     

Concomitant malignant mesothelioma of the pleura,peritoneum, and tunica vaginalis testis

We describe the cytohistological, immunohistochemical and ultrastructural findings in a 55-yr-old-man with history of asbestos exposure and diffuse malignant mesothelioma (DMM) of the pleura, peritoneum, and tunica vaginalis presenting with chest pain and scrotal swelling. Pleural fine-needle aspiration (FNA) revealed mesenchymal elements and spindle-shaped epithelial-like cells, while biopsy showed pure sarcomatous tumor invading lung parenchyma. In both samples tumor cells coexpressed cytokeratin and vimentin. Peritoneal and hydrocele effusions contained aggregates of malignant mesothelial cells. Electron microscopy showed intermediate filaments, rare desmosomes and sparse microvilli. Morphological findings were consistent with a DMM, with a biphasic pattern in the pleura and an epithelial one in the peritoneum and tunica vaginalis. Although the possibility of a multicentric origin cannot be ruled out, clinical chronologic sequence suggests that the pleura was the primary involved site, followed by spread to peritoneum and tunica vaginalis. Diagn Cytopathol 1996;14:243–248. © 1996 Wiley-Liss, Inc.     

Leiomyosarcoma arising from tunica vaginalis testis: a case report

Benign and malignant soft tissue tumors of the paratesticular region i.e. those arising from the testicular tunics, epididymis and spermatic cord are uncommon. Of these, leiomyosarcoma arising from the tunica vaginalis is extremely rare. On extensive computerised search, a single case has been reported till date in the literature. We hereby report one such case because of its rarity.     

Mesothelioma of the tunica vaginalis testis with prominent adenomatoid features: a case report

Malignant mesotheliomas of the testis arise from the tunica vaginalis, formed from the evagination of the abdominal peritoneum into the scrotum. It is an extremely rare tumor representing 0.3% to 5% of all malignant mesotheliomas. We presented an interesting case of 68-year-old male with swelling and slightly painful in the right scrotum. Histologically, the lesion were composed of small tubular, microcystic, gland lined by flattened epithelioid cells and vague signet ring cells set in a myxofibrous stroma, which is resemblance to adenomatoid tumor. But the tumor cells showed significant atypical cytologic morphology and invaded into spermatic cord tissue, which indicated the diagnosis of malignant tumor. Immunohistochemistry study showed positive expression of CK, CK5/6, CK7, Calretinin, D2-40 and Vimentin which indicated the diagnosis of malignant mesothelioma. This case of mesothelioma should be classified as epithelial in type. To our knowledge, the mesothelioma of the tunica vaginalis testis with adenomatoid tumor-like microscopic features is very rare.     

Myxoid leiomyoma of tunica vaginalis testis

Myxoid leiomyoma is an extremely rare tumor, presenting as a scrotal mass. We report a case of 60 years male, who presented with a painless scrotal mass and operated as secondary hydrocoele. This lesion should be differentiated from other myxoid tumors and tumors with myxoid degeneration.     

Well-differentiated papillary mesothelioma of the tunica vaginalis: A case report with aspirate cytologic,immunohistochemical, and ultrastructural studies

A case of a well-differentiated papillary mesothelioma of the tunica vaginalis testis in a 70-year-old man, who presented with a 1-month history of scrotal swelling with hydrocele, is described. Fine needle aspiration cytology of the hydrocele demonstrated a papillary cluster of uniform round cells with minimal atypia, reminiscent of mesothelial cells. Macroscopically, the lesion was characterized by a solitary, well-circumscribed papillary soft tumor measuring 1.2×1.2×1.0 cm³. Histologically, the tumor exhibited papillary or tubulopapillary proliferation of predominantly bland cuboidal cells. No cellular pleomorphism, mitotic figures, necrosis, or stromal invasion was noted. Immunohistochemically, the tumor was positive for CAM5.2, epithelial membrane antigen, vimentin, calretinin, and D2-40, but negative for carcinoembryonic antigen. Ki-67 index was less than 1%. Ultrastructurally, the tumor cells showed numerous microvilli, mitochondria, rough endoplasmic reticulum, microfilaments, and desmosomes. The patient is alive with no evidence of disease at 18 months after right radical orchiectomy. Ki67 may be potentially a good maker for differentiating low-grade from high-grade mesothelioma.     

Reactive pseudo-glandular mesothelial hyperplasia in testis tunica vaginalis: a case report

A case of benign reactive pseudo-glandular mesothelial hyperplasia arising in the context of chronic vaginitis in presented: morphological and immunohistochemical investigations and differential diagnoses are described.     

Papillary serous carcinoma of the tunica vaginalis testis

This is a case report of a testicular papillary serous carcinoma of ovarian type (PSCOT) diagnosed in a 50-year-old man. The tumor presented in the form of multiple papillary exophytic excrescencies on the visceral tunica vaginalis testis lining the inner surface of a hydrocele sac. The tumor was histologically a papillary serous carcinoma with numerous psammoma bodies, indistinguishable from similar tumors arising on the surface of the ovary. Following the tumor's surgical removal, the patient was treated with the same drugs used to treat ovarian serous carcinomas, and he is alive two years after the initial diagnosis. PSCOT must be distinguished from mesothelioma of the tunica vaginalis testis, a tumor with a most unfavorable prognosis. As shown here, immunohistochemical findings can be useful for formulating the correct diagnosis of PSCOT.     

Mesotheliomas of the tunica vaginalis testis and hernial sacs

Summary Three histologically and immunohistochemically well-documented cases of mesothelioma of the tunica vaginalis testis and hernial sac are presented. Analysis and follow-up data on our three patients and a review of 30 previously reported cases have revealed a varied and often unpredictable clinical course. A classification into high- and lowgrade malignant tumours is suggested, based on clinical and pathological findings.     

Well differentiated (benign) papillary mesothelioma of the tunica vaginalis.

An unusual mesothelial lesion occurred in the tunica vaginalis of the testis. It conformed histologically and immunohistochemically to well differentiated papillary mesothelioma of the peritoneum. Its aetiology remains uncertain, but this lesion, more than likely, is innocuous. It is important to recognise this entity, which is not well documented in the tunica vaginalis, because it may be misdiagnosed as a malignant mesothelioma and the patient may be subjected to unnecessary treatment.