Malignant mesothelioma of the tunica vaginalis testis

Abstract

Malignant mesothelioma of the tunica vaginalis is rare, and is usually not diagnosed until surgery is undertaken. Reports on the ultrasound features of this tumour are limited. We present an unusual case with ultrasound features mimicking an adenomatoid tumour.

Sonography of the Scrotum

“…Hydrocele, either simple or complex is present and may be associated with: (1) multiple extratesticular papillary projections of mixed echogenicity (Boyum & Wasserman 2008, as cited in Fields et al, 1992; (2) multiple extratesticular nodular masses of increased echogenicity (Boyum & Wasserman, 2008, as cited in Bruno et al, 2002and Tyagi et al, 1989; (3) focal irregular thickening of the tunica vaginalis testis (Bruno et al, 2002); (4) a simple hydrocele as the only finding (Boyum & Wasserman, 2008, as cited in Jalon et al, 2003 and (5) A single hypoechoic mass located in the epididymal head (Boyum & Wasserman, 2008;Mak et al, 2004b). With color Doppler sonography, mesothelioma is hypovascular [ Fig.…”

“…As the tunica vaginalis is a layer of reflected peritoneum, mesothelioma can occur in the scrotal sac. Although trauma, herniorrhaphy and long term hydrocele (Mak et al, 2004b, as cited in Gurdal & Erol, 2001) have been considered as the predisposing factors for development of malignant mesothelioma, the only well established risk factor is asbestos exposure (Boyum & Wasserman, 2008). Patients with malignant mesothelioma of the tunica vaginalis frequently have a progressively enlarging hydrocele and less frequently a scrotal mass, rapid re-accumulation of fluid after aspiration raises the suggestion of malignancy (Mak et al, 2004b, as cited in Wolanske & Nino-Murcia, 2001).…”

“…With color Doppler sonography, mesothelioma is hypovascular [ Fig. 12] (Bruno et al, 2002;Mak et al, 2004b;Wang et al, 2005).…”

Testicular Mesothelioma

“…The rarity of the testicular mesothelioma makes it extremely difficult to diagnose [61].The primary malignant neoplasm of the testis serous membranes, its epididymis and the spermatic cord is very difficult for intravital diagnosis, not only in earlier, but in the later stages of the disease. In addition, the diagnosis of mesothelioma is imperfect, usually heavily delayed and it is no accident that this tumor remains an enigma for the oncologist [53].…”

Para- and Intratesticular Aspects of Malignant Mesothelioma

“…Recently, color Doppler sonography has emerged as a possible imaging modality for preoperative diagnosis. Initial studies (Mak et al, 2004;Wang et al, 2005;Wolanske & Nino-Murcia, 2001) documented an intratesticular mass that was hypovascular in comparison to surrounding testicular tissue, and 2 recent cases (Aggarwal et al, 2010;Boyum and Wasserman, 2008) report hypervascularity within a paratesticular nodule or stalk arising from the tunica vaginalis. Thus, discrepancies in color Doppler sonography, whether hypovascularity or hypervascularity of paratesticular nodules, may increase preoperative diagnosis of malignant mesotheliomas (Klaassen & Lehrhoff, 2010).…”