White Karah D, Bohy Kimberlee C, Muirhead DesiRae M, Kerkvliet Amy M
Pathology Residency Program, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Sanford Health Pathology Clinic, Sioux Falls, South Dakota.
S D Med. 2019 Nov;72(11):532-534.
Paratesticular malignant mesothelioma is a rare and potentially aggressive malignancy, accounting for approxi- mately 0.3-1.4 percent of all malignant mesotheliomas. The tumor presents as a painless scrotal mass associated with recurrent hydrocele. We report an incidental case of paratesticular malignant mesothelioma in a 73-year- old man that was found during an operation to remove a progressively enlarging, symptomatic hydrocele. During the procedure the surgeon noted multiple, irregular, extratesticular masses, and subsequently submitted a sam- ple for frozen section analysis. Frozen section assessment revealed a papillary-appearing, malignant tumor and the surgeon proceeded with a radical orchiectomy. Examination of the orchiectomy specimen revealed multiple, yellow-white, papillary, exophytic excrescences that tracked along the hydrocele and coursed up the tunica vagi- nalis of the spermatic cord. Microscopically, the tumor was composed of papillary fronds and nests of malignant cells with enlarged, hyperchromatic, pleomorphic nuclei. Pankeratin and calretinin immunohistochemical stains strongly highlighted the tumor cells, supporting the diagnosis of malignant mesothelioma. Suspicion of malignant mesothelioma as a differential diagnosis in the setting of enlarging hydrocele is imperative, as the care of the patient is dramatically altered to address the aggressive nature of the disease and the unfavorable outcome.
睾丸旁恶性间皮瘤是一种罕见且具有潜在侵袭性的恶性肿瘤，约占所有恶性间皮瘤的0.3%-1.4%。该肿瘤表现为与复发性鞘膜积液相关的无痛性阴囊肿块。我们报告一例73岁男性睾丸旁恶性间皮瘤的偶然病例，该病例是在为一名进行性增大、有症状的鞘膜积液患者进行手术时发现的。手术过程中，外科医生注意到多个不规则的睾丸外肿块，随后送检样本进行冰冻切片分析。冰冻切片评估显示为乳头状外观的恶性肿瘤，外科医生随后进行了根治性睾丸切除术。对睾丸切除标本的检查发现多个黄白色、乳头状、外生性赘生物，这些赘生物沿着鞘膜积液生长并向上延伸至精索的鞘膜。显微镜下，肿瘤由乳头状叶和恶性细胞巢组成，细胞核增大、深染、多形性。全角蛋白和钙视网膜蛋白免疫组化染色强烈突出肿瘤细胞，支持恶性间皮瘤的诊断。在鞘膜积液增大的情况下，怀疑恶性间皮瘤作为鉴别诊断至关重要，因为患者的治疗会因疾病的侵袭性和不良预后而发生显著改变。
