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Mesothelioma Of The Tunica Vaginalis Testis


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Mesothelioma Help Center - Mesothelioma Of The Tunica Vaginalis Testis

Mesothelioma of the tunica vaginalis testis is the least common type of malignant mesothelioma (amounting to less than 100 of all documented cases of the disease) and affects the section of the mesothelium called the tunica vaginalis testis (the mesothelial lining around the testes). Most patients are in their 50s or older, but about ten percent of the patients are younger than 25 years. Patients generally present with a hydrocele (an accumulation of serous fluid in a sac-like cavity (as the scrotum)) or hernia. Treatment is usually a high inguinal orchiectomy (surgical excision of the entire affected testis through an incision in the lower abdomen - called also orchidectomy). Prognosis is somewhat better than for pleural mesothelioma.

Symptoms that are associated with this cancer include:

  • Hydrocele (a fluid filled sac attached to a testicle)
  • Suspected hernia

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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