Trenti Emanuela, Palermo Salvatore Mario, D'Elia Carolina, Comploj Evi, Pycha Alexander, Carella Rodolfo, Pycha Armin
General Hospital of Bolzano, Department of Urology, Bolzano.
Arch Ital Urol Androl. 2018 Sep 30;90(3):212-214. doi: 10.4081/aiua.2018.3.212.
Mesothelioma of the tunica vaginalis testis is a extremely rare tumor and represents 0.3 to 0.5% of all malignant mesotheliomas. Exposure to asbestos often precedes illness. Because of its low incidence and nonspecific clinical presentation, it is mostly diagnosed accidentally during surgery for other reasons and the prognosis is usually poor. We present a case of a patient with a mesothelioma of tunica vaginalis testis, diagnosed secondarily during hydrocele surgery, with long-term survival after radical surgery.
a 40 years old patient was admitted to our department for routine surgery of a left hydrocele. During the operation a frozen section analysis was requested because of the unusual nodular thickening of the tunica vaginalis: the examination revealed a diffuse malignant mesothelioma with epithelioid structure and tubular-papillary proliferation. Therefore a left hemi-scrotectomy with left inguinal lymph node dissection was performed.
The definitive histology confirmed the previous report of diffuse malignant mesothelioma with angio-invasion but normal testicle findings and negative lymph nodes. No metastases were found on the CT-scan. For the first 2 years a CT was repeated every 4 months, for other 3 years every 6 months and then yearly. Six years after surgery the patient is classified as no evidence of disease.
malignant mesothelioma of the tunica vaginalis testis is a rare entity, often initially thought to be a hydrocele or an epididymal cyst. An aggressive approach with hemiscrotectomy with or without inguinal and retroperitoneal lymphadenectomy can reduce the risk of recurrence.
睾丸鞘膜间皮瘤是一种极为罕见的肿瘤，占所有恶性间皮瘤的0.3%至0.5%。发病前常存在石棉接触史。由于其发病率低且临床表现不具特异性，大多在因其他原因进行手术时意外确诊，预后通常较差。我们报告一例睾丸鞘膜间皮瘤患者，在鞘膜积液手术中被二次诊断，根治性手术后长期存活。
一名40岁患者因左侧鞘膜积液入我院接受常规手术。术中因鞘膜出现异常结节状增厚而进行冰冻切片分析：检查显示为弥漫性恶性间皮瘤，具有上皮样结构和管状乳头样增生。因此，实施了左侧阴囊半切除术及左侧腹股沟淋巴结清扫术。
最终组织学检查证实先前弥漫性恶性间皮瘤伴血管侵犯的报告，但睾丸检查结果正常且淋巴结阴性。CT扫描未发现转移。术后前2年每4个月复查一次CT，接下来3年每6个月复查一次，之后每年复查一次。术后6年，患者被归类为无疾病证据。
睾丸鞘膜恶性间皮瘤是一种罕见疾病，最初常被认为是鞘膜积液或附睾囊肿。采用阴囊半切除术加或不加腹股沟及腹膜后淋巴结清扫术的积极治疗方法可降低复发风险。
