Mesothelioma

Malignant mesothelioma is a disease affecting serosal surfaces derived from the mesothelium comprising the pleura, peritoneum, pericardium, and tunica vaginalis testis [...]

Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: analysis of published case-series data

Purpose Mesothelioma of the tunica vaginalis testis (MTVT) is a rare tumor, and currently, there are no published treatment recommendations. Methods We performed a systematic literature review and synthesized clinical presentation, clinicopathological factors associated with metastatic disease, treatment options, and outcomes in men with MTVT. Results We included 170 publications providing data on 275 patients. Metastatic disease occurred in 84/275 (31%) men with malignant MTVT: Most common sites included retroperitoneal lymph nodes (LNs) (40/84, 48%), lungs (30/84, 36%), and inguinal LNs (23/84, 27%). Invasion of the spermatic cord or scrotum was the only risk factor for local recurrence [odds ratio (OR) 3.21, 95% confidence interval (CI) 1.36–7.57]. Metastatic disease was associated with age ≥ 42 years (OR 3.02, 95% CI 1.33–6.86), tumor size ≥ 49 mm (OR 6.17, 95% CI 1.84–20.74), presence of necrosis (OR 8.31, 95% CI 1.58–43.62), high mitotic index (OR 13.36, 95% CI 1.53–116.51) or angiolymphatic invasion (OR 3.75, 95% CI 1.02–13.80), and local recurrence (OR 4.35, 95% CI 2.00–9.44). Complete remission in the metastatic setting was observed in five patients, most of whom were treated with multimodal therapy. Median survival in patients with metastatic disease was 18 months (IQR 7–43). Conclusion Malignant MTVT is a rare but aggressive disease. Since local recurrence is a risk factor for metastatic progression, we recommend aggressive local treatment. Survival and response to any treatment in the metastatic setting are limited.

Mesothelioma of tunica vaginalis testis: A case report of two subtypes

Level of Evidence: 4

The Tunica vaginalis testis metastasis as the first clinical manifestation of pancreatic adenocarcinoma: a case report and and literature review

Background: Metastases from pancreas or ampullary malignancies are common, but spread to the testicle and paratesticular tissue is exceedingly rare. To our knowledge, few than 30 cases have been previously reported in the literature. More rarely, it is to be found with tunica vaginalis testis metastasis without involvement of testicle and epididymis. Case presentation: A 65-year-male with complaints of left painless scrotal swellings for over 1 week was referred to the Department of Urology . Scrotal ultrasound demonstrated a left sided hydrocele with paratesticular masses.The chest computed tomography showed lung metastases and left enlarged supraclavicular lymph node. The preoperative diagnosis was left testicular tumor with lung metastasis.Then, a left radical orchidectomy was performed with high ligation of the spermatic cord and postoperative histopathology showed that it was suggestive of metastatic tumors. Abdominal computed tomography revealed the presence of a tumor in the tail of the pancreas. Tumor markers cancer antigen CA 19-9 were elevated almost 6-fold levels. The outcome of this patient was unsatisfactory and died 3 months later. Conclusions: This case highlighted that metastatic carcinoma from the pancreas must be considered in the differential diagnosis of scrotal enlargement. Older patient age is suggestive of a secondary testicular tumor. In addition, careful clinical and radiological examination has become the imaging modality.