Abstract
Introduction: Malignant mesothelioma is a rare tumour. Tunica vaginalis as the primary site is even rarer. Approximately, 300 cases have been reported to date in the literature. Its prevalence is 0.2 per million. Case Presentation: 67-year-old male, came with complaints of painless swelling in left hemiscrotum for 5 months. On examination, he had an enlarged left hemiscrotum. Ultrasound showed an enlarged left testis with hydrocele, with multiple deposits in tunica vaginalis with increased vascularity. Preoperative tumour markers and metastatic workup were within normal limits. He underwent a left high-inguinal orchidectomy. Microscopy showed intra-cystic papillae with a fibro-vascular core lined by stratified columnar cells with eosinophilic cytoplasm and marked atypia. IHC was positive for calretinin, WT-1, D2-40, and negative for PAX 8, CK 5/6, and vimentin. Biopsy suggestive of malignant mesothelioma of the tunica vaginalis. His follow-up PET scan was normal.
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