Department of Pathology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.
Adv Anat Pathol. 2010 Jan;17(1):53-70. doi: 10.1097/PAP.0b013e3181c66fbc.
Paratesticular mesotheliomas are rare tumors with 223 cases described so far. The sole plausible causative factor so far ascertained in the pathogenesis of these tumors is asbestos, which however is found in only around 30% to 40% of such cases. The age range of affected individuals is wide, mostly adults and the elderly, but also includes young people and children. The most common presenting symptom is either hydrocele of unknown origin or intrascrotal mass. When hydrocele is the presenting symptom, these tumors are often clinically overlooked and the diagnosis is delayed. Most paratesticular mesotheliomas arise in the tunica vaginalis, but primary tumors of the spermatic cord and epididymis are also on record. Tumors arising from the peritoneal mesothelium of a hernia sac are excluded from this group. The correct diagnosis is almost always made after histologic examination of the operative specimen. Immunohistochemistry and electron microscopy are always helpful and sometimes necessary tools for diagnosis. So far very few cases have been identified or suspected preoperatively on cytologic examination. Three clinicopathologic types of malignant mesotheliomas of the male genital tract are recognized: diffuse tubulo-papillary mesothelioma, well-differentiated papillary mesothelioma, and multicystic mesothelioma. The histologic subtypes are almost always pure epithelial or biphasic. The differential diagnosis is mainly with serous papillary tumors arising from Mullerian vestiges, but several diverse primary or secondary tumors also need to be considered. A clinicopathologic evaluation of a case of tunical diffuse mesothelioma in a 74-year-old male from the AMR Series is the starting point for this general review.
副睾间皮瘤是一种罕见的肿瘤，目前已有 223 例病例描述。迄今为止，在这些肿瘤的发病机制中，唯一可以确定的合理致病因素是石棉，但只有大约 30%到 40%的病例中发现了石棉。受影响个体的年龄范围很广，主要是成年人和老年人，但也包括年轻人和儿童。最常见的表现症状是原因不明的阴囊积水或鞘膜内肿块。当阴囊积水是主要表现症状时，这些肿瘤通常在临床上被忽视，导致诊断延迟。大多数副睾间皮瘤起源于鞘膜，但精索和附睾的原发性肿瘤也有记录。疝囊腹膜间皮来源的肿瘤被排除在该组之外。正确的诊断几乎总是在手术标本的组织学检查后做出。免疫组织化学和电子显微镜检查对于诊断总是有帮助的，有时也是必要的工具。迄今为止，通过细胞学检查在术前识别或怀疑的病例非常少。男性生殖器官的恶性间皮瘤有三种临床病理类型：弥漫性管状乳头状间皮瘤、分化良好的乳头状间皮瘤和多囊性间皮瘤。组织学亚型几乎总是纯上皮或双相型。鉴别诊断主要与来自米勒氏残余物的浆液性乳头状肿瘤有关，但也需要考虑几种不同的原发性或继发性肿瘤。从 AMR 系列中选择的 74 岁男性鞘膜弥漫性间皮瘤病例的临床病理评估是对该综述的起点。
