Well-differentiated papillary mesothelioma of the tunica vaginalis: A case report with aspirate cytologic, immunohistochemical, and ultrastructural studies
ABSTRACT A case of a well-differentiated papillary mesothelioma of the tunica vaginalis testis in a 70-year-old man, who presented with a 1-month history of scrotal swelling with hydrocele, is described. Fine needle aspiration cytology of the hydrocele demonstrated a papillary cluster of uniform round cells with minimal atypia, reminiscent of mesothelial cells. Macroscopically, the lesion was characterized by a solitary, well-circumscribed papillary soft tumor measuring 1.2 x 1.2 x 1.0 cm(3). Histologically, the tumor exhibited papillary or tubulopapillary proliferation of predominantly bland cuboidal cells. No cellular pleomorphism, mitotic figures, necrosis, or stromal invasion was noted. Immunohistochemically, the tumor was positive for CAM5.2, epithelial membrane antigen, vimentin, calretinin, and D2-40, but negative for carcinoembryonic antigen. Ki-67 index was less than 1%. Ultrastructurally, the tumor cells showed numerous microvilli, mitochondria, rough endoplasmic reticulum, microfilaments, and desmosomes. The patient is alive with no evidence of disease at 18 months after right radical orchiectomy. Ki67 may be potentially a good maker for differentiating low-grade from high-grade mesothelioma.
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ABSTRACT: Mesothelioma of tunica vaginalis is a rare neoplasm, typically demonstrating frankly malignant morphology and aggressive behavior. Rare cases of well-differentiated papillary mesotheliomas have also been reported, which, in contrast, demonstrate indolent behavior. There are, however, cases which do not fit into the well-differentiated or diffuse malignant mesothelioma categories and can be considered mesothelioma of tunica vaginalis of "uncertain malignant potential", which is an emerging diagnostic category. A 57-year-old man presented with a neoplasm in a hydrocele sac. The neoplasm was non-invasive, but showed focal complex and solid growth and it was difficult to categorize either as well-differentiated papillary mesotheliomas or malignant mesothelioma. After the initial limited resection, the patient underwent radical orchiectomy with hemiscrotectomy and is alive and without disease progression after 6 years. Documentation of these rare tumors will allow their distinction from true malignant mesotheliomas and will facilitate the development of specific treatment recommendations.Diagnostic Pathology 08/2011; 6:78. DOI:10.1186/1746-1596-6-78 · 2.41 Impact Factor
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ABSTRACT: Mesothelioma of the tunica vaginalis testis is a rare and aggressive cancer; fewer than 90 cases have been reported. It occurs in all age groups, but its highest incidence appears between 55 and 75 years of age. Less than 5% of all malignant mesotheliomas arise from the tunica vaginalis testis. The authors present a rare case of localized malignant mesothelioma of the tunica vaginalis testis. Diagnosis and treatment are described. Mesothelioma of the tunica vaginalis testis can be asymptomatic for a long time. In more than half of the cases, the clinical manifestations imitate a hydrocele or a tumor mass in the scrotum. Despite treatment, this tumor has a very poor prognosis with a median survival of 23 months.Onkologie 02/2012; 35(1-2):46-8. DOI:10.1159/000335884 · 0.84 Impact Factor
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ABSTRACT: Well-differentiated papillary mesothelioma of the peritoneum (WDPMP) is an uncommon subtype of epithelioid mesothelioma. Usually, WDPMP has a benign course, while a few patients have multiple recurrence and malignant transformation on long-term follow-up. The histology of WDPMP has been well studied compared with the cytology. Although accurate diagnosis is based only on histology and immunohistochemical stains, knowledge of the cytologic features of WDPMP in context with clinical and radiologic features is essential to predict a preoperative diagnosis and guide proper management, after excluding reactive mesothelial hyperplasia, malignant mesothelioma, and serous neoplasms of the ovaries and peritoneum. Surgical excision gives a favorable outcome.American Journal of Clinical Pathology 08/2014; 142(2):233-42. DOI:10.1309/AJCPOTO9LBB4UKWC · 3.01 Impact Factor