Intrascrotal malignant mesothelioma diagnosed after surgery for hydrocele testis: a case report

We report here a case of intrascrotal malignant mesothelioma, arising from the tunica vaginalis, which was diagnosed after surgery for hydrocele testis. A 52-year-old man underwent left hydrocelectomy for hydrocele testis. After pathological diagnosis as malignant mesothelioma from the specimen of tunica vaginalis, left radical orchiectomy was performed. The patient had no exposure to asbestos and there has been no evidence of recurrence.     

睾丸鞘膜恶性间皮瘤1例并文献复习

目的：分析睾丸鞘膜恶性间皮瘤并总结其临床特点、诊断及治疗。方法：报告1例睾丸鞘膜恶性间皮瘤的I艋床表现、治疗经过、病理结果,并回顾文献对该病的相关报道。结果：患者经手术治疗后出院,术后病理提示左睾丸鞘膜恶性间皮瘤,肿瘤未侵及睾丸。精索切缘未见肿瘤残余。免疫组化标记：CK5／6（＋）,Vimentin（＋）,EMA（＋）,CK8（＋）。术后密切随访中。结论：睾丸鞘膜恶性间皮瘤是一种罕见的泌尿生殖系恶性肿瘤,诊断主要依据病理,治疗以根治性睾丸切除术为一线治疗方式,预后多不良。该病的发生可能与石棉等多种因素相关。     

睾丸鞘膜恶性间皮瘤1例报告

目的 探讨睾丸鞘膜恶性间皮瘤的临床特征及诊治方法.方法 报告1例睾丸鞘膜恶性间皮瘤患者的临床资料.男性,73岁,临床表现右侧阴囊进行性增大1年,B超睾丸周围可见约7.5 cm×4.1 cm液性暗区.检索Pubmed和CBM数据库相关文献进行学习.结果 患者行右侧睾丸鞘膜切除术,术后病理:睾丸鞘膜间皮细胞增生,伴非典型性增生,局灶恶变,免疫组化:CK5/6(+),Calretinin(+),E-cadlherin(+).3周后行右睾丸切除,术后11个月患者出现右侧阴囊肿物及腹股沟淋巴结肿大,行右侧阴囊肿物切除及腹股沟淋巴结切除,术后病理:脂肪结缔组织及纤维组织中恶性间皮瘤浸润,免疫组化:CK5/6(+),Calretinin灶状(+).结论 睾丸鞘膜恶性间皮瘤临床罕见,生物学行为进展快,临床症状不典型,缺少特异性肿瘤标记物,术前诊断较难,诊断主要依据病理,治疗以根治性手术为主,术后需长期严密随访,患者预后差.     

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.     

Malignant mesothelioma of the male genital tract: report of two cases

Two patients with urogenital mesothelioma are presented. The first patient had a malignant epithelial mesothelioma involving the scrotum and the peritoneal cavity. This patient was treated by extensive surgery and intraperitoneal perioperative chemotherapy; he is well and alive 62 months after diagnosis. The second patient had an aggressive malignant epithelioid mesothelioma of the tunica vaginalis testis; he died 24 months after diagnosis, with locoregional and metastatic recurrent disease, in spite of surgical and systemic chemotherapy treatment. Calretinin immunostains were positive in the first case and negative in the second. Eighty-eight previously published cases of malignant mesothelioma of the tunica vaginalis testis were found in a review of the literature to date. Mesothelioma of the tunica vaginalis testis usually presents as a scrotal mass, thus requiring urologist skills for first line treatment. A multidisciplinary approach is advised when dealing with the malignant form, considering its aggressive natural history.     

Multicystic malignant mesothelioma of the tunica vaginalis with an unusually indolent clinical course

We report an extremely rare case of a multicystic malignant mesothelioma in the tunica vaginalis with an unusually indolent clinical course. A 48-year-old man presented with a one-month history of painless swelling of right scrotal contents. Ultrasonography and computed tomography (CT) revealed a multicystic mass in the right scrotal sac with evidence of neither distant nor lymph node metastases. The testicular tumor markers were within the normal limits. Inguinal orchiectomy was performed under the suspicion of a malignant tumor. The cystic tumor consisted of fibrocellular, microcystic and adenomatoid elements microscopically was diagnosed biphasic malignant mesothelioma of tunica vaginalis but no invasion into the testis, epididymis and also scrotum. The patient has been disease-free for 72 months and is being followed on an outpatient basis with no further adjuvant therapy.     

Synchronous bilateral malignant mesothelioma of tunica vaginalis testis: early diagnosis

We report a case of bilateral synchronous malignant mesothelioma of the testis. A 21-year-old man presented with an acute scrotum after 3 months of recurrent pain on the right side. Ultrasonography demonstrated an irregular thickening of the tunica vaginalis testis, scrotolyths, and an increased blood flow to the right epididymis testis. Bilateral exploration revealed torsion of the hydatid and a bilateral malignant mesothelioma of the tunica vaginalis. One year later, elective bilateral exploration showed one minute area on the parietal tunica vaginalis of malignant mesothelioma. After 2 years of follow-up, the patient had no signs of distant disease.     

Malignant mesothelioma of the tunica vaginalis testis

A 74-year-old man underwent hydrocelectomy following repeated fluid aspiration, six times during the previous year. Tunica vaginalis was opened after removing about 70 ml of yellow clear fluid and many miliary sized soft papillary tumors were seen inside of the vaginal sac. These tumors were attached to the sac so closely that they were easily rubbed off with a towel. The pathological specimen showed a papillary structure combined with solid sheets of cells. The cells were cuboidal and polygonal with sparse mitotic figures and the nuclei were round or oval with prominent nucleoli. Malignancy was strongly suspected and orchiectomy was performed a month later. Pathologic examination of the operated material showed that the tumor cells invaded into the tunica albuginea, and the diagnosis of malignant mesothelioma was finally made. The patient has remained well with neither recurrence nor metastasis for fifteen months.     

Malignant mesothelioma of the tunica vaginalis testis

Malignant mesothelioma of the tunica vaginalis is an extremely rare tumor. Appropriate treatment consists of inquinal orchiectomy with close followup. Treatment of locally recurrent malignant mesothelioma of the tunica vaginalis has not been standardized. We recommend radical resection for the initial presentation of locally recurrent disease rather than saving surgical resection as salvage therapy after other treatment modalities have failed. We report case 37 of malignant mesothelioma of the tunica vaginalis and review the literature.     

睾丸鞘膜恶性间皮瘤一例报告

目的 探讨睾丸鞘膜恶性间皮瘤临床表现、病理特征、治疗方法和预后情况.方法 睾丸鞘膜恶性间皮瘤患者1例,34岁,因右侧阴囊肿大5年,进行性增大15d入院.查体:右侧阴囊肿大、囊性,于睾丸上方可触及质硬肿物,表面光滑、轻压痛,与睾丸、附睾界限尚清.β-人绒毛膜促性腺激素和甲胎蛋白检测正常.阴囊超声于右侧睾丸鞘膜上方探及2.05 cm×1.97 cm混合回声的实性肿物,边界毛糙,内部回声欠均匀.结果蛛网膜下腔麻醉下手术切除鞘膜及肿物.病理报告:肿物切面灰白色,质硬,边界欠清晰.镜下可见鞘膜间皮细胞向上皮细胞和间质细胞双向分化,以上皮细胞增殖为主,上皮细胞有明显异形性,可见有丝分裂相;免疫组化染色角蛋白和波形蛋白呈强阳性.病理诊断为低度恶性的睾丸鞘膜间皮瘤.1个月后行右侧睾丸根治加右侧阴囊切除术,肿瘤未浸润临近的精索、睾丸、微血管和淋巴管等.随访38个月,患者生存良好,肿瘤无复发.结论睾丸鞘膜恶性间皮瘤多表现为鞘膜积液,确诊需依靠病理检查,本病易发生浸润和远处转移,患者生存期较短,术后需密切随访.低度恶性的间皮瘤患者经早期治疗生存期可明显延长. :肿物切面灰白色,质硬,边界欠清晰.镜下可见鞘膜间皮细胞向上皮细胞和间质细胞双 分化,以上皮细胞增殖为主,上皮细胞有明显异形性,可见有丝分裂相;免疫组化染色角蛋白和波形蛋白呈强阳性.病理诊断为低度恶性的睾丸鞘膜间皮瘤.1个月后行右侧睾丸根治加右侧阴囊切除术,肿瘤未浸润临近的精索、睾丸、微血管和淋巴管等.随访38个月,患者生存良好,肿瘤无复发.结论睾丸鞘膜恶性间皮瘤多表现为鞘膜积液,确诊需依靠病理检查,本病易发生浸润和远处转移,患者生存期较短,术后需密切随访.低度恶性的间皮瘤患者经早期治疗生存期可明显延长. :肿物切面灰白色,质硬,边界欠清晰.镜下可见鞘膜间皮细胞向上皮细胞和间质细胞双 分化,以上皮细胞增殖为主,上皮细胞有明显异形性,可见有丝分裂相;免疫组化染色角蛋白和波形蛋白呈强阳性.病理诊断为低度恶性的睾丸鞘膜间皮瘤.1个月后行右侧睾丸根治加右侧阴囊切除术,肿瘤未浸润临近的精索、睾丸、微血管和淋巴管等.随     

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

Case report of a new case of malignant mesothelioma of the tunica vaginalis testis. A mediterranean male age 62, presented with enlargement and swelling of the scrotum, treated as orchiepydidymitis within the previous 3 months. Physical and ultrasonography examination showed a left scrotal mass with extension to the skin of the scrotum. After surgery (orchiectomy and partial hemiscrotectomy) and histopathology diagnosis of locally advanced malignant mesothelioma, CT showed metastasis in retroperitoneum, Lung and Liver. The patient undergoes chemotherapy and radiotheraphy with a poor prognose. We review the diagnosis, histopathology and therapeutical approach for this uncommon kind of paratesticular tumor (less than 80 cases reported in the last 30 years).     

Malignes Mesotheliom der Tunica vaginalis testis

A case of malignant mesothelioma of the tunica vaginalis testis is reported in a 77-year-old male patient. There was no history of asbestos exposure. Recurrent right hydrocele with a papillar inguinal mass was the main clinical feature. An inguinal radical orchiectomy with en bloc resection of the surrounding tissue was performed. The therapeutic options for this rare, but aggressive neoplasm are discussed. Because of the disappointing results of antineoplastic chemotherapy or radiation therapy, the importance of initial radical surgical treatment with complete excision is emphasized.     

Ileal conduit anastomosis using modified Javid Shunt as temporary stent

A case of biphasic malignant mesothelioma of the tunica vaginalis occurring in a sixty-four-year-old man is described. The tumor metastasized widely and led to the patient's death two and one-half years after diagnosis. Review of the literature revealed 7 cases of malignant mesothelioma of tunica vaginalis. These tumors appeared highly aggressive with early onset of metastasis. Histologically, the tumors may be epithelial, fibrous, or biphasic. In contrast to the benign variants of mesotheliomas, these tumors often show significant nuclear atypia, mitotic activity, and invasion of the epididymis, spermatic cord, lymphatic spaces, or the fibrous tissue of the tunica.     

Extensive palliative surgery for advanced mesothelioma of the tunica vaginalis

Malignant mesothelioma of the tunica vaginalis is a rare tumor managed principally by radical surgical resection. Chemotherapy and radiotherapy have limited efficacy. We report on a 67-year-old man with severe debilitation from multiple scrotal and inguinal recurrences of a malignant mesothelioma originating in the right tunica vaginalis. Local pain from extensive tumor spread prevented ambulation. Aggressive surgical debridement (total penectomy and scrotectomy) and perineal urethrostomy afforded the patient significant improvement in his quality of life before he finally died of the disease 3 years after diagnosis.     

Malignant mesothelioma of tunica vaginalis testis

Malignant mesothelioma of the tunica vaginalis is rare, but sometimes curable. It is similar to malignant mesothelioma of the peritoneum and of the pleura, and is likewise associated with asbestos exposure. We report a case, with correlative computed tomography, ultrasound, and gross pathology images that demonstrate tiny tumor implants studding the vaginalis testis. The literature is reviewed.     

Well-differentiated papillary mesothelioma occurring in the tunica vaginalis of the testis with contralateral atypical mesothelial hyperplasia

Well-differentiated papillary mesothelioma (WDPM) occurs rarely in the paratesticular region, with only a handful of published case reports. Often presenting with recurrent hydrocele, WDPM is a multifocal mesothelial proliferation with a predominantly indolent clinical course. Accordingly, pathologic distinction of this lesion from true malignant mesothelioma is crucial, although it may be difficult because of the variability of associated histologic features. In addition, rare cases of WDPM have progressed to malignant mesothelioma, leading to its classification as a tumor of low malignant potential. Here, we report a case of multifocal WDPM occurring in the tunica vaginalis and tunica albuginea, with contralateral atypical mesothelial hyperplasia, a potentially premalignant lesion.     

Radiologic findings of mesothelioma at the tunica vaginalis

Malignant mesothelioma of the tunica vaginalis testis is a rare, but often fatal, malignancy that usually appears during the fourth decade and has a strong relationship with occupational exposure to asbestos and long-lasting hydrocele. We present a case involving a 36-year-old man without a history of hydrocele, trauma, or exposure to asbestos who developed malignant mesothelioma.     

Fibrous pseudotumor of the vaginalis testis: report of a case

In this study, the authors have reported a case of a benign fibrous pseudotumor of the tunica vaginalis testis in a 24-year old man who was admitted with a left scrotal mass. Scrotal ultrasound and surgical investigation demonstrated the presence of a left testicular tumor; radical orchiectomy was performed by inguinal route. Microscopic examination revealed a pseudotumor of the testicular tunica vaginalis. As this is an uncommon lesion and preoperative diagnosis is difficult, unnecessary radical orchidectomy is often carried out.