Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 741-744. doi: 10.19723/j.issn.1671-167X.2024.04.031

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Well-differentiated papillary mesothelial tumour of the tunica vaginalis: A case report

Yangyi FANG1,Qiang LI2,Zhigao HUANG1,Min LU3,Kai HONG1,Shudong ZHANG1,*()   

  1. 1. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, Beijing Zhongguancun Hospital, Beijing 100190, China
    3. Department of Pathology, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-03-18 Online:2024-08-18 Published:2024-07-23
  • Contact: Shudong ZHANG E-mail:zhangshudong@bjmu.edu.cn

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Abstract:

The mesothelium, which consists of a monolayer of mesothelial cells, extends over the surface of the serosal cavities (pleura, pericardium, peritoneum and tunica vaginalis). Mesothelial tumours of the tunica vaginalis is rare compared with those arise from pleura or peritoneum. According to World Health Organization 2022 Classification of Urinary and Male Genital Tumours (5th edition), mesothelial tumours of the tunica vaginalis were categorized into adenomatoid tumour, well-differentiated papillary mesothelial tumour (WDPMT) and mesothelioma. Since WDPMT of tunica vaginalis was rare, there was no consensus concerning the treatment of it. In this case report, a 29-year-old man who had endured intermittent right scrotal pain for 8 months, aggravating scrotal pain for 2 weeks was admitted. No symptoms, such as frequent, urgent, or painful urination were shown. Physical examination revealed the enlargement and tenderness of right scrotum, with no signs of lifting pain. The most recent scrotal ultrasonography before surgery revealed right hydrocele with maximum depth of 4 centimeters and poor blood flow of right testis. Under the circumstance of patient’ s chronic history of testicular hydrocele, he underwent an emergency operation of right scrotal exploration and hydrocelectomy under epidural anesthesia. After opening the vagina tunic cavity, spot-like bleeding was observed on the right testicle, epididymis and vaginalis surface. The vaginalis was obviously thickened and the inner and outer walls were smooth. The post-operative histopathology revealed a grayish-brown tissue with a thickness of 0.3-0.5 cm, smooth inner and outer walls, and a suspected WDPMT with a diameter of 1. 5 cm. Immunohistochemical staining showed positive for Calretinin, BAP1, WT-1, CK5/6, D2-40 and P16,which confirmed the diagnosis of WDPMT. To sum up, the purpose of this case report was to raise awareness of a rare disease WDPMT, which was usually asymptomatic and could be diagnosed by pathology and immunohistochemistry. The disease should be differentiated from testicular torsion, epididymitis, orchitis and oblique inguinal hernia in symptoms, and from malignant mesothelioma and adenomatoid tumour in pathology. Because of the rarity of the cases, there was no unified standard for the treatment of WDPMT at present. The common treatment methods reported in literature included orchidectomy and vaginectomy. Due to the lack of understanding of this disease, postoperative follow-up was still recommended for at least 5 years.

Key words: Mesothelial tumour, well-differentiated, papillary, Tunica vaginalis, Prognosis

CLC Number: 

  • R737.2

Figure 1

Preoperative ultrasonography and intraoperative findings of patient A, normal blood flow in left testis; B, lack of blood flow in right testis; C, spots of hemorrhage on the surface of right testis, epididymis and tunica vaginalis."

Figure 2

Morphological features of well-differentiated papillary mesothelial tumor A, papillae lined by a single row of cuboidal cells in the absence of stromal invasion (HE ×100); B, CK5/6 positive (IHC ×100); C, Calretinin positive (IHC ×100); D, D2-40 positive (IHC ×100)."

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