JCU - January 2022 - 41

951291
URO
Journal of Clinical UrologyGreen-Lott et al.
Case Series
Mesothelioma of tunica vaginalis testis:
A case report of two subtypes
Ashley-Marie Y Green-Lott1 , Nicholas R Rocco2,
Brett M Lowenthal3 and Philip H Kim1,4
Abstract
Level of Evidence: 4
Journal of Clinical Urology
2022, Vol. 15(1) 41 -45
© British Association of
Urological Surgeons 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/2051415820951291
journals.sagepub.com/home/uro
https://doi.org/10.1177/2051415820951291
Introduction
Mesotheliomas of the serous tunica vaginalis are rare neoplasms
with a poorly understood etiopathogenesis. Three
distinct subtypes exist: (a) well-differentiated papillary
mesothelioma (WDPM), (b) mesothelioma of uncertain
malignant potential (MUMP) and (c) malignant mesothelioma
(MM).1 WDPM is thought to have an indolent
course that can be managed conservatively.1 In contrast,
MM is an aggressive variant with a reported median survival
after diagnosis ranging between 18 and 23 months.2
MUMP has an unclear prognosis, although malignant
transformation has been reported.3
Preoperative diagnosis of these tumors can be challenging
given the lack of specific clinical features, radiologic
findings and reliable tumor markers. Moreover, there is no
established consensus regarding management beyond radical
orchiectomy. Given the paucity of literature regarding
adjuvant treatment and follow-up, it is imperative to report
all outcomes of cases. Here we describe cases of WDPM
and MM and how their management and outcomes compare
to previous reports in the literature.
Case Series
A 66-year-old man (patient A) presented with painless,
gradually enlarging, left-sided scrotal swelling. Clinical
examination suggested a left-sided hydrocele. An ultrasound
(US) of the scrotum revealed a large, complex left
hydrocele with several irregular echogenic masses contiguous
with and adjacent to the left testis, some with blood flow
that appeared to extend through the tunica (Figure 1(a)).
Magnetic resonance imaging of the pelvis demonstrated
multiple nodular and polypoid masses abutting the wall of
1 School of Medicine, Uniformed Services University of the Health
Sciences, USA
2Department of Urology, Naval Medical Center San Diego, USA
3Department of Pathology, Kaiser Permanente San Diego, USA
4Department of Urology, Kaiser Permanente San Diego, USA
Corresponding author:
Ashley-Marie Y Green-Lott, School of Medicine, Uniformed Services
University of the Health Sciences, 4301 Jones Bridge Road, Bethesda,
MD 20815, USA.
Email: agreenlott@gmail.com
the hydrocele (Figure 1(b-d)). He underwent an uncomplicated
left radical orchiectomy. The hydrocele sac was kept
intact and opened on the back table revealing multiple
masses originating from the inner tunica. Histopathologic
sections demonstrated a predominantly epithelioid malignancy
with a minor sarcomatoid component forming a papillary/tubulopapillary
architecture arising from the tunica
vaginalis. The cells demonstrated a spectrum from relatively
bland mesothelium to marked nuclear pleomorphism,
nuclear overlapping, and high mitotic index. Overall, the
histopathologic findings were diagnostic of MM with negative
margins (Figure 2(a-d)). Cross-sectional imaging of the
chest, abdomen and pelvis revealed no evidence of metastasis.
He was evaluated by radiation oncology and medical
oncology for adjuvant treatment for clinical stage I MM. He
opted for chemotherapy and completed four cycles of pemetrexed
plus cisplatin. Postchemotherapy surveillance plan
was history and physical exam with computed tomography
scans every 6 months for 2 years, then yearly thereafter. He
was found to have recurrence 54 months after his initial
orchiectomy. Imaging revealed a new 2-cm hypermetabolic
retroperitoneal lymph node. Biopsy confirmed metastatic
malignant mesothelioma.
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JCU - January 2022

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