MALIGNANT MESOTHELIOMA OF THE TUNICA VAGINALIS

Fewer than 100 cases of gonadal mesothelioma have been reported in the literature, and although most patients are in their 50s or older, approximately 10% of the patients are younger than 25 years. Asbestos exposure is documented in approximately one-half of the more recently reported cases. Patients generally present with a hydrocele or hernia. An accurate preoperative diagnosis has been reported in only two cases.

All patients with a suspected testicular malignancy should undergo a radical or high inguinal orchiectomy.

Local resection of the tumor or hydrocelectomy is associated with a high recurrence rate compared with high inguinal orchiectomy. Because preoperative diagnosis of gonadal mesothelioma is difficult, management should be as for any testicular tumor. The inguinal approach avoids interruption of the scrotal lymphatics, which would alter the metastatic pathway of the tumor, and also allows complete removal of the spermatic cord up to the internal ring. Patients with evidence of disease extending into the retroperitoneal nodes should undergo a retroperitoneal lymphadenectomy.

The overall recurrence rate (local and disseminated) for gonadal mesothelioma can be as high as 52%, with 38% of patients dying of disease progression. Local recurrence occurs in 36% of patients who undergo local resection of the hydrocele wall; 10% after scrotal orchiectomy and 12% after inguinal orchiectomy. More than 60% of recurrences developed within the first 2 years of the follow-up. The median survival of the patients averaged 23 months. There are little data regarding the use of adjuvant therapy after resection of gonadal mesothelioma.

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