JCU - January 2022 - 43

Green-Lott et al.
43
Figure 2. Microscopic histologic H&E-stained sections from patient A: malignant mesothelioma. (a) Low-power view of the
large polypoid neoplasm (left) arising from the tunica vaginalis with background unremarkable testicular parenchyma (right)
(20× magnification). (b) Medium-power magnification of the neoplasm demonstrating the papillary/tubulopapillary architecture
(100× magnification). (c) High-power view of the biphasic neoplasm demonstrating the (left) epithelioid component and (right)
sarcomatoid component. The neoplasm demonstrates the malignant features with marked nuclear pleomorphism, nuclear
stratification and overlapping, and high mitotic index (400× magnification). (d) High-power magnification demonstrating the
(bottom) sarcomatoid component with (top) nuclear spindling, pleomorphism, increased mitotic figures, and tumor necrosis (200×
magnification).
in the literature.4 Unlike mesotheliomas at other sites, mesotheliomas
of the tunica vaginalis testis (MTVT) are less
commonly associated with asbestos exposure and smoking.5
The subtypes of MTVT exhibit distinct morphologic,
immunohistochemical and prognostic differences. As seen
in our case, WDPMs display exclusive papillary architecture,3
without evidence of stromal invasion and negativity
for calretinin. In contrast, our case of MM demonstrates a
predominantly complex morphology, stromal invasion and
diffuse positivity for calretinin. Both of our cases display
an outcome similar to what has previously been reported in
the literature - an indolent course for WDPM and high risk
of recurrence despite adjuvant chemotherapy for MM.
WDPM is the least commonly encountered subtype with
a generally favorable prognosis. Unlike our patient with
WDPM who was diagnosed at age 47, the mean patient age
of diagnosis of MTVT is 60 years.6 However, he presented
similarly to most patients with localized disease who
exhibit nondisease-specific features such as hydroceles,
epididymitis, spermatoceles and scrotal hernia. The most
common treatment approach is radical orchiectomy.
However, wide local excision without orchiectomy has
been reported as well.1 In our case, there was no preoperative
suspicion for a tunica vaginalis mass and radical orchiectomy
was not performed. Preemptive radical orchiectomy
in the setting of findings on exam or imaging suggestive of
mesothelioma has also been discussed; Patient B did not
exhibit any. Given wide-local excision with pathologic
negative margins, a multidisciplinary group elected to treat
conservatively with surveillance.
MM is an aggressive variant with a poor prognosis.
Recurrence tends to occur within 12 to 24 months and previously
published series reported a median overall survival
of 18 to 23 months.5,7 The tumor may recur locally in the

JCU - January 2022

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