|Year : 2004 | Volume
| Issue : 2 | Page : 67-68
Mesothelioma of tunica vaginalis
Dilip Kumar Pal, Mallika Basuroy, Manoj Kumar Chowdhury
Dilip Kumar Pal
Vinayak Garden, Flat No. A/ 3d, 41, Simla Road, Kolkata-700 006
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pal DK, Basuroy M, Chowdhury MK. Mesothelioma of tunica vaginalis. Indian J Urol 2004;20:67-8
| Case Report|| |
A 42-year old male patient presented to our O.P.D. with rapidly enlarging left hemiscrotum for last three months. On clinical examination he was found to have a hard, nontender swelling (5cm x 4cm) separated from the left testis, surrounded by hydrocele with a normal right hemiscrotum. Left sided superficial inguinal lymph nodes were palpable. Investigations reveled Hb-10gm% with normal renal biochemical parameters. X-Ray chest was normal. His serum beta human chorionic gonadotropin was 1.391U/ml and alpha-feto protein was 0.4611U/ml. USG of the left scrotum demonstrated a large avascular mass of nonhomogeneous echotexture with multiple cystic component quite separated from the testis, which was surrounded by clearfluid [Figure - 1]. Multiple lymph nodes over the inguinal ligaments were noted without any pre or Para aortic lymph nodes. CT scan also confirmed the same findings [Figure - 2]. FNABC from the mass suggested features of Mesothelioma. A left sided inguinal orchidectomy with block dissection of left inguinal lymph nodes was done. Histopathology of the resected specimen showed features of mesothelioma with papillary pattern without any solid cord like element,arising from the tunica vaginalis [Figure - 3]. He did not turn up for follow up after 6 months and till then he did not have any sign of metastasis. After two years the patient returned with respiratory distress due to pulmonary metastasis with pleural effusion. CT scan of chest and abdomen showed multiple metastasis to the chest with pleural effusion and metastasis to the pre and paraaortic lymph nodes.the patient died within two days of admission due to multisystem failure.
| Comments|| |
Mesothelioma is a relatively rare tumour arising from the mesothelial cells lining the plura, peritoneum and pericardium. Tunica vaginalis is an additional potential site for malignant mesothelioma and 80 cases have been recorded in the world literature  . The only established risk factor is asbestos exposure, which was found in 34% of reported patients  . Tunica vaginalis mesothelioma has an aggressive biological behaviour with a 53% mortality rate after a two years median follow up  . The aggressive nature of the tumour demands a radical surgery like radical orchidectomy , or hemiscrotectomy ,, as local recurrences have been reported up to 36%1. They are usually not responsive to radiotherapy or chemotherapy  .
Preoperative diagnoses of these tumours are difficult on clinical grounds, as most of the patients present with hydrocele without any palpable testicular anbormalities. Though there is no obligatory guideline for evaluation for hydrocele but the resent case stresses on the ultrasonographic evaluation for rapidly developing hydrocele of recent origin.
| References|| |
|1.||Iczkowski HK, Kath G, Dani SZ and Clapp WL. Malignant mesothelioma of tunica vaginalis testis: A fatal case with liver metastasis. J Urol 2002;167:645 646. |
|2.||Plas E, Riedl CR and Pfluger H. Malignant mesothelioma of the tunica vaginalis testis: Review of literature and assessment of prognostic factors.Cancerl998;83:2437. |
|3.||Golash A and Jenkins BJ. Mesitheloma of the epididymis. BJ Urol2000;85:3. |
|4.||Huncharek M, Klassen M, Christiani D. Mesothelioma of the tunica vaginalis testis with possible occupational asbestos exposure. BJ Urol 1995; 75 : 679-680. |
|5.||Fitzmaurice H, Hotiana M Z, Crucioli V. Malignant Mesothelioma of the tunica vaginalis testis. B J Urol 1987;60:184. |
[Figure - 1], [Figure - 2], [Figure - 3]