Moore AJ, Parker RJ, Wiggins J.

Department of Respiratory Medicine, Wexham Park Hospital, Wexham, Slough, Berkshire, UK. a.moore@ic.ac.uk

Abstract

Malignant mesothelioma is a fatal asbestos-associated malignancy originating from the lining cells (mesothelium) of the pleural and peritoneal cavities, as well as the pericardium and the tunica vaginalis. The exact prevalence is unknown but it is estimated that mesotheliomas represent less than 1% of all cancers. Its incidence is increasing, with an expected peak in the next 10-20 years. Pleural malignant mesothelioma is the most common form of mesothelioma. Typical presenting features are those of chest pain and dyspnoea. Breathlessness due to a pleural effusion without chest pain is reported in about 30% of patients. A chest wall mass, weight loss, sweating, abdominal pain and ascites (due to peritoneal involvement) are less common presentations. Mesothelioma is directly attributable to occupational asbestos exposure with a history of exposure in over 90% of cases. There is also evidence that mesothelioma may result from both para-occupational exposure and non-occupational “environmental” exposure. Idiopathic or spontaneous mesothelioma can also occur in the absence of any exposure to asbestos, with a spontaneous rate in humans of around one per million. A combination of accurate exposure history, along with examination radiology and pathology are essential to make the diagnosis. Distinguishing malignant from benign pleural disease can be challenging. The most helpful CT findings suggesting malignant pleural disease are 1) a circumferential pleural rind, 2) nodular pleural thickening, 3) pleural thickening of > 1 cm and 4) mediastinal pleural involvement. Involvement of a multidisciplinary team is recommended to ensure prompt and appropriate management, using a framework of radiotherapy, chemotherapy, surgery and symptom palliation with end of life care. Compensation issues must also be considered. Life expectancy in malignant mesothelioma is poor, with a median survival of about one year following diagnosis.

de Lima GR, de Oliveira VP, Reis PH, Pinheiro FG, Lima MV, Gonzaga-Silva LF.

Federal University of Ceará, Fortaleza, Brazil. rafael.urologia@yahoo.com.br

Abstract

Malignant mesotheliomas of the tunica vaginalis are extremely rare tumors, especially in young patients. We report a case of a 15-year old patient presenting with clinical signs of hydrocele. Preoperative ultrasound scanning revealed two papillary lesions. Initially, before mesothelioma was suspected, the patient was submitted to focal resection of the macroscopic lesions. Following diagnosis by histopathology, the patient was submitted to radical orchiectomy and hemiscrotectomy. The patient presents no signs of local or systemic recurrence at the time of writing. A review of the literature on the subject has been included.

Goel A, Agrawal A, Gupta R, Hari S, Dey AB.

Senior Research Associate, Medicine, AIIMS, New Delhi 110029, India. ashgoe@yahoo.com.

Abstract

Introduction:
Mesotheliomas are rare tumours that usually are seen in the pleura after asbestos exposure. Mesotheliomas have been reported around the testicular region but are even rarer following trauma, herniorrhaphy and long term hydrocoele.

Case presentation: An elderly male farmer presented to us with an insidious onset of painless swelling in his left lower limb which gradually progressive. At the time of presentation it had involved his entire limb. A hard palpable mass of size 5 * 4 cms was detected in the left iliac fossa and a testicular enlargement was noted on the left side. The ultrasound of the testes showed that the left testis was enlarged 3.9*3*3.2 cms showing diffusely heterogenous echo-texture and irregular nodular surface with irregular hypoechoic thickening of the scrotal wall with left sided hydrocele. A separate hypoechoic *1.2 cms lesion was visualized in the anterior scrotal wall. FNAC from the scrotal mass showed tumour cells of simialr morphology present singly in monolayered sheets and in three dimensional fragments. The overall immunomorphological features suggested a malignant mesothelioma likely to have arisen from the tunica vaginalis.

Conclusion: In conclusion, though a rare tumor, malignant mesothelioma of the tunica vaginalis of the testis should be considered whenever a paratesticular mass lesion is seen even without a history of trauma or asbestos exposure as is highlighted in this case. Ultrasound findings are helpful and fine needle aspiration of the tumor may assist in arrival at a diagnosis. Surgical orchidectomy remains the modality of treatment.

Matsuzaki K, Nakajima T, Katoh T, Kitoh H, Mizoguchi K, Akakura K, Inoue T.

Department of Urology, Tokyo Kousei Nenkin Hospital.

Abstract

A 70-year-old man was referred to our hospital with a painless swelling of the light scrotal contents. Ultrasonography and computed tomographic scan revealed a hydrocele testis and irregular masses in the scrotum. The patient underwent left orchidectomy under the diagnosis of left intrascrotal tumor. Pathological diagnosis was malignant mesothelioma. The patient has not received additional therapy because there has been no evidence of metastasis. He has been free of disease 3 months postoperatively.

Washino S, Terauchi F, Matsuzaki A, Kobayashi Y.

Department of Urology, Jichi Saitama Medical Center.

Abstract

We report here a case of malignant mesothelioma presenting as a perineal and intrascrotal mass. A 42-year-old Japanese male presented with an enlarging mass in the perineum and intrascrotum. Although the initial clinical diagnosis was perineal abscess, angiography revealed a tumor in the perineum and intrascrotum. The tumor was resected, and the pathological examination revealed malignant mesothelioma. Two months after the operation, a hard irregular mass with severe hemorrhage was noticed in the perineum, and was resected. A few weeks after the second operation local recurrence and, inguinal and intrapelvic retroperitoneal lymphadenopathy were found. Radiotherapy to recurrent sites was not effective. The patient died six months after the initiation of therapy. To our knowledge, 24 cases of malignant mesothelioma in the perineum or intrascrotum were reported in Japan and this case was thought to be the 25th case in Japan.

Klaunig JE.

Department of Pharmacology and Toxicology, Center for Environmental Health, Indiana University School of Medicine, MS A503, 635 Barnhill Drive, Indianapolis, Indiana 46202, USA. jklauni@iupui.edu

Abstract

The induction of cancer by chemicals is a multiple-stage process. Acrylamide is carcinogenic to experimental mice and rats, causing tumors at multiple organ sites in both species when given in drinking water or by other means. In mice, acrylamide increased the incidence and multiplicity of lung tumors and skin tumors. In two bioassays in rats, acrylamide administered in drinking water consistently induced mesotheliomas of the testes, thyroid tumors, and mammary gland tumors. In addition, brain tumors appeared to be increased. In one of the rat bioassays, pituitary tumors, pheochromocytomas, uterine tumors, and pituitary tumors were noted. The conversion of acrylamide metabolically to the reactive, mutagenic, and genotoxic product, glycidamide, can occur in both rodent and humans. Glycidamide and frequently acrylamide have been positive for mutagenicity and DNA reactivity in a number of in vitro and in vivo assays. The effects of chronic exposure of glycidamide to rodents have not been reported. Epidemiologic studies of workers for possible health effects from exposures to acrylamide have not shown a consistent increase in cancer risk. Although an increase in the risk for pancreatic cancer (almost double) was seen in highly exposed workers, no exposure response relationship could be determined. The mode of action remains unclear for acrylamide-induced rodent carcinogenicity, but support for a genotoxic mechanism based on in vitro and in vivo DNA reactivity assays cannot be ruled out. In addition, the pattern of tumor formation in the rat following chronic exposure supports a genotoxic mode of action but also suggests a potential role of endocrine modification.

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.

Ikegami Y, Kawai N, Tozawa K, Hayashi Y, Kohri K.

Department of Nephro-urology, University Graduate School of Medical Sciences, Nagoya, Japan. urouroyokun@aichi-cc.jp

Abstract

We report an extremely rare case of malignant mesothelioma in the tunica vaginalis testis. A 67-year-old man was referred to our hospital complaining of painless swelling in the right scrotum. Ultrasonography and computed tomography demonstrated a mass of approximately 6 cm in the right scrotum. He underwent tumor resection under a diagnosis of right intrascrotal tumor. The histopathological diagnosis was malignant mesothelioma, and he died 26 months later from multiple metastases. Asbestos may be a significant contributor to malignant mesothelioma in Japan. There have been 46 cases reported in urology departments in this country of the related symptoms, but only two of these have been clearly attributable to asbestos, which may be due to the investigations being insufficient to obtain a definitive diagnosis. In addition, this symptom is often diagnosed preoperatively as hydrocele testis; it is therefore important to carry out ultrasonography when a hydrocele testis has been diagnosed.

Maruyama H, Ohyama N, Hosokawa Y, Momose H, Yamada K, Tsutsumi M, Kuniyasu H, Enomoto Y, Uematsu K, Konishi Y.

Department of Pathology, Hoshigaoka Koseinenkin Hospital, Hirakata, Japan. hiromaruyama@sannet.ne.jp

Abstract

Reported herein is a case of serous borderline tumor (SBT, ovarian epithelial type tumor) of the paratestis, involving the tunica vaginalis, in a 64-year-old man. The patient complained of right hydrocele; puncture cytology of the turbid fluid pointed to an adenocarcinoma. Right orchiectomy was performed and multiple micronodules were grossly observed in the paratestis. On microscopy small papillary epithelial lesions were found with psammoma bodies and intraglandular papillary lesions were irregularly recognized in the stroma of the paratestis, similar to SBT of the ovary. The tumor cells had often short microvilli. Mucin production was evident on PAS and colloid iron staining. Both papillary and glandular epithelial cells were positive on immunohistochemistry for Ber-EP4/epithelial antigen, low-molecular-weight cytokeratin (CAM5.2), cytokeratin 7 and estrogen and progesterone hormone receptors, but negative for CEA, cytokeratin 20 and calretinin. The average proliferative index was approximately 10.5% as assessed on Ki-67 (MIB-1) staining. Ultrastructurally, the cells did not demonstrate any well-developed microvilli or secretory granules and immunohistochemical findings supported SBT of Müllerian type (ovarian epithelial type tumor), while excluding a papillary type of malignant mesothelioma. The lesion in the present case was concluded to be a testicular serous tumor of Müllerian type, similar to SBT of the ovary.

Menegozzo M, Izzo F, Canfora ML, Petronzio MF, Menegozzo S.

Registro Mesoteliomi della Campania, Dipartimento di Medicina Sperimentale, Seconda Università degli Studi di Napoli.

Abstract

Campania Mesothelioma Register was established in 2002; its purpose is to record every case of malignant mesothelioma that occurs in the registered population of Campania. Its aim is to identify new dangerous asbestos sources, by giving patients a questionnaire about their working and living habits. The questionnaire used is by National Mesothelioma Register (ReNaM). Analyzing carefully the answers to the questionnaire, it is possible to classify patients’ exposure with a code given by ReNaM. By means of a recognition identification network, COR Campania identified 492 cases of malignant mesothelioma (pleura, pericardium, peritoneum and tunica vaginalis of the testis) diagnosed between 1996-2007. The analysis of the ReNaM questionnaire confirms a prevalence of professional exposures (71%), however unknown exposures (15%) also play an important role. The economic sector that determined the greatest number of professional exposures are Construction (17.5%), Industrial Metalwork (13.13%), Railway Car (9.3%), Vehicle production and maintenance (8.16%), Ship building (7.5%).