Radiologic Findings of Mesothelioma at the Tunica Vaginalis
Soonchunhyang University, Onyang, Chungcheongnam-do, South KoreaUrology (Impact Factor: 2.19). 05/2012; 80(1):e3-5. DOI: 10.1016/j.urology.2012.02.050
Malignant mesothelioma of the tunica vaginalis testis is a rare, but often fatal, malignancy that usually appears during the fourth decade and has a strong relationship with occupational exposure to asbestos and long-lasting hydrocele. We present a case involving a 36-year-old man without a history of hydrocele, trauma, or exposure to asbestos who developed malignant mesothelioma.
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ABSTRACT: Hydrocelectomy and spermatocelectomy are routine scrotal surgeries. A significant number of the surgical specimens are sent for pathological analysis. However, no analysis has been done to examine outcomes and necessity. This results in significant potentially unnecessary costs to both the patient and the health care system. We evaluated the outcomes and the surgical pathological analysis of hydroceles and spermatoceles. We performed a single-institution retrospective chart review of all patients who underwent their first surgery for hydrocele or spermatocele between January 2000 and August 2013. We determined the number of cases in which a surgical specimen was sent for pathological exam. The cost for each specimen was estimated by our Department of Pathology. A total of 264 routine scrotal cases were performed over the 14-year period. Surgical specimens were sent for pathologic analysis in 51% (n=102) of hydrocelectomy cases and in more than 90% (n=57) of spermatocelectomies. Of the pathologic specimens obtained, none showed any indications of malignancy. The estimated direct total cost for pathologic analysis amounted to $49,449 for this cohort. As no malignancies were detected in 159 hydrocele and spermatocele specimens over the 14 years of this study, it suggests that the pathologic analysis is of little clinical benefit. Forgoing surgical pathologic analysis of these specimens would result in a significant cost savings to both the patient and the health care system.
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ABSTRACT: To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis. We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis. A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection. A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity. • Mesotheliomas of the tunica vaginalis are rare, often challenging to diagnose preoperatively. • Most common finding is a complex hydrocele with hypervascular parietal vegetations. • Septated hydrocele, nodules without hydrocele, a thick-walled paratesticular cyst are less common. • Preoperative diagnosis may allow aggressive surgical approach and, possibly, a better prognosis.
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