Malignant mesothelioma of the spermatic cord mimicking a benign inguinoscrotal swelling: case report with review of literature

Abstract

BackgroundSpermatic cord malignant mesotheliomas (SCM) are extremely rare tumours arising from the tunica vaginalis of the spermatic cord (only 18 cases reported—worldwide in the literature). Paratesticular malignant mesotheliomas (PMM) account for about 0.3–1.4% of all mesotheliomas, while those from the spermatic cord account for less than 10% of paratesticular tumours. Spermatic cord mesotheliomas may be overlooked commonly owing to its unique ability to mimic benign disorders associated with a thickened cord, leading to loss of timely management in many cases. Hence, this case report hence serves to provide pointers to the urologist/surgeon and alerts them towards timely diagnosis and early management of SCM’s besides adding to its limited literature.Case presentationWe present a case of spermatic cord mesothelioma (SCM) in a 39-year-old male presenting to our clinic with persistentcomplaints of left inguinoscrotal swelling with a vague dull-aching, poorly localising pain sensation over the inguinoscrotal region associated with a persistent dragging sensation for more than a year. Initial evaluation suggested and inclined us towards the diagnosis a benign pathology (spermatocele); however, the persistence of symptoms (pain and swelling) despite prior therapeutic measures initiated elsewhere prompted us to consider an FNAC (which was benign) and surgical exploration which surprisingly revealed the diagnosis of SCM. Owing to the wide spread nature of the disease, the patient was started on palliative chemotherapy. He is currently is doing clinically well on a 1-year follow-up.ConclusionSpermatic cord malignant mesothelioma is an extremely rare tumour with an unique tendency to masquerade and mimic cord thickening also associated with several other benign groin/inguinoscrotal swellings. In all such cases, a high index of suspicion should be entertained by the urologist, even in the absence of classical risk factors for SCM like prior asbestos exposure while evaluating patients presenting with persistent expanding inguinoscrotal swellings associated with non-resolving symptoms.