Candura Stefano M, Canto Andrea, Amatu Alessio, Gerardini Matteo, Stella Giorgio, Mensi Mario, Poggi Guido
Unit of Occupational Medicine, University of Pavia, Salvatore Maugeri Foundation, Work and Rehabilitation, IRCCS, Scientific Institute of Pavia, Pavia, Italy.
Anticancer Res. 2008 Mar-Apr;28(2B):1365-8.
Malignant mesothelioma of the tunica vaginalis testis is a rare and aggressive asbestos-related malignancy that may pose difficult diagnostic problems. After 16 years of asbestos exposure, a 38-year-old petrochemical worker came to our notice with acute right testicular pain and swelling, simulating torsion of the spermatic cord. Histopathology of surgical samples of the tunica vaginalis revealed tubulopapillary, epithelioid neoplastic proliferation. Immunohistochemical staining for the epithelial glycoprotein Ber-EP4 was negative, whereas results were positive for mesothelial markers, thus leading to the diagnosis of epithelial mesothelioma. The tumour infiltrated the testicular surface and the epididymis, but no distant metastases were found. The patient was treated with radical inguinal orchidectomy without adjuvant therapy and is free from disease 15 months after diagnosis. Tunical mesothelioma may simulate metastatic carcinoma at routine histopathological examination. Immunohistochemistry and occupational anamnesis are helpful for the correct diagnosis, which, in turn, is important for prognosis and treatment, and in relation to legal issues when asbestos is involved in the causation of the disease.
睾丸鞘膜恶性间皮瘤是一种罕见且侵袭性强的与石棉相关的恶性肿瘤，可能会带来诊断难题。一名38岁的石化工人在接触石棉16年后，因突发右侧睾丸疼痛和肿胀前来就诊，症状类似精索扭转。睾丸鞘膜手术样本的组织病理学显示为管状乳头状、上皮样肿瘤性增殖。上皮糖蛋白Ber-EP4的免疫组化染色为阴性，而间皮标志物结果为阳性，从而诊断为上皮样间皮瘤。肿瘤侵犯了睾丸表面和附睾，但未发现远处转移。患者接受了根治性腹股沟睾丸切除术，未进行辅助治疗，诊断后15个月无疾病迹象。在常规组织病理学检查中，鞘膜间皮瘤可能类似转移性癌。免疫组化和职业病史对正确诊断有帮助，而正确诊断反过来对于预后和治疗很重要，并且在石棉与疾病病因相关的法律问题中也很重要。
