ABSTRACT
A 93-year-old man with chronic hydrocele. A hydrocelectomy was performed and the intraoperative findings revealed several nodules in the tunica vaginalis. The pathological diagnosis was malignant mesothelioma. A second procedure was performed to do a radical inguinal orchiectomy with hemiscrotectomy. The patient denied any history of exposure to asbestos. The surgical margins were free of any tumours. Therefore, no adjuvant treatments were given. After three months the patient is asymptomatic. Scrotal examination is normal and control CT scan shows no evidence of lymphatic disease or metastases.
Key words: malignant mesothelioma, tunica vaginalis, hydrocele, scrotal pain.
INTRODUCTION
Malignant mesothelioma of the tunica vaginalis (MMTV) is a rare neoplasm which represents around 5% of mesotheliomas1. Asbestos exposure is the main risk factor associated1,2. It has also been associated with epididymitis3 or hydrocele4. Clinical presentation is unspecific: hydrocele, epididymitis, inguinal hernia, etc. Most of the cases occur in patients between 55 and 75 years old, but 10% occur in patients younger than 25. Preoperative suspicion is low.
Therefore, the majority of diagnoses are postoperative.
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The tumour has an invasive growth, which commonly infiltrates the testicular parenchyma, epididymis and spermatic cord, and from there it can reach the peritoneum. Microscopically, cells tend to be cuboid with an eosinophilic cytoplasm. Inmunohistochemistry (figure 2) is necessary for dianognosis9,16,18,19. The tumour shows strong positivity for Calretinin, WT1 (Willm’s Tumour antibody), EMA (epithelial membrane antigen), Thrombomodulin, Cytokeratin 7, variable positivity to Cytokeratin 5/6 and negativity to Cytokeratin 20 and Carcinoembryonic antigen. MMTV have been subclassified into four groups: epithelial (65%), sarcomatous (15%), desmoplasic (2%) and biphasic