Abstract
IntroductionMesotheliomas 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 presentationAn 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.ConclusionIn 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.
Highlights
Mesotheliomas are rare tumours that usually are seen in the pleura after asbestos exposure
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
Summary
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. It is known that findings missed during the initial patient examination, remain mysteriously elusive during the further course of treatment. 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. Written informed consent for publication of this case report could not be obtained from the patient or from their of kin. Extensive attempts made to trace the patient proved futile. We believe this case report holds worthwhile clinical information which could not be communicated as effectively in any other way. The same case have been submitted by a separate set of authors in another publication[2]. AG wrote the first draft of the manuscript. RG provided insight and valuable inputs into the manuscript. ABD was responsible for the overall care of the patient and the final decision on the patient management rested with him
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