Malignant mesothelioma of the tunica vaginalis testis in a petrochemical worker exposed to asbestos
Thursday, May 29th, 2008.
Anticancer Research. 2008 Mar-Apr;28(2B):1365-8. [Link]
Candura SM, Canto A, Amatu A, Gerardini M, Stella G, Mensi M, Poggi G.
Unit of Occupational Medicine, University of Pavia, Salvatore Maugeri Foundation, Work and Rehabilitation, IRCCS, Scientific Institute of Pavia, Pavia, Italy. stefano.candura@fsm.it
Abstract
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.
Glossary
- adjuvant therapy
- (add-joo-vunt) treatment used in addition to the main treatment. It usually refers to hormonal therapy, chemotherapy, or radiation added after surgery to increase the chances of curing the disease or keeping it in check.
- therapy
- any of the measures taken to treat a disease. Unproven therapy is any therapy that has not been scientifically tested and approved. Use of an unproven therapy instead of standard (proven) therapy is called alternative therapy. Some alternative therapies have dangerous or even life-threatening side effects. For others, the main danger is that a patient may lose the opportunity to benefit from standard therapy. Complementary therapy, on the other hand, refers to therapies used in addition to standard therapy. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of standard cancer therapy, or improve a patient's sense of well-being. The ACS recommends that patients considering use of any alternative or complementary therapy discuss this with their health care team.
- rehabilitation
- activities to help a person adjust, heal, and return to a full, productive life after injury or illness. This may involve physical restoration (such as the use of prostheses, exercises, and physical therapy), counseling, and emotional support.
- prognosis
- (prog-no-sis) a prediction of the course of disease; the outlook for the cure of the patient. For example, women with breast cancer that was detected early and who received prompt treatment have a good prognosis.
- diagnosis
- identifying a disease by its signs or symptoms, and by using imaging procedures and laboratory findings. The earlier a diagnosis of cancer is made, the better the chance for long-term survival.
- carcinoma
- (car-sin-o-ma) a malignant tumor that begins in the lining layer (epithelial cells) of organs. At least 80% of all cancers are carcinomas.
- mesothelioma
- a tumor derived from mesothelial tissue, such as the peritoneum (lining the abdomen) or pleura (lining the lungs). More on mesothelioma.
- tunica vaginalis
- The serous sheath of the testis and epididymis, derived from the peritoneum; it consists of outer parietal and inner visceral serous layers.
