Testicular Mesothelioma: Tunica Vaginalis
Understanding Testicular Mesothelioma
Testicular mesothelioma is a confusing diagnosis for researches. Most people who have been diagnosed with mesothelioma can pinpoint their disease to a time period in which he/she ingested or inhaled asbestos fibers. Most patients with testicular mesothelioma do not have a history of exposure to asbestos, and because it is such a rare diagnosis, there is little research on it.
Regardless of the limited cases of men who have been diagnosed with this cancer, their prognosis for a full recovery is much better than most people who have been diagnosed with the other types of mesothelioma. The average survival rate is about 1 year, although there is a patient that lived for 15 years after he was diagnosed.
Asbestos and Testicular Cancer / Mesothelioma
Little is known about the development of testicular mesothelioma. Researchers theorize that the point of origin is the tunica vaginalis, the membrane that is made of mesothelial cells and can be found in most of the membranous linings. There are firm whitish yellow nodules that are found on the surface of the tunica vaginalis and eventually the nodules can encase the scrotum causing the thickening of the tunica vaginalis.
Although there is not currently a theory about how asbestos exposure may cause a tumor in the testicles, it is known that once the fibers in asbestos enter the body, they become lodged in organs thus causing infection and inflammation. The fibers cause cancerous cells to abnormally divide which causes a fluid buildup and the formation of tumors. When a cell has become cancerous, it can no longer regulate its own growth cycle and division, thus the cells in the testicle divide without restraint and eventually leads to the formation of tumors.
Symptoms Diagnosis Of Testicular Mesothelioma
Testicular mesothelioma does not have a set of symptoms that are unique to testicular cancer. Often men with this cancer will receive the wrong diagnosis since the doctors originally diagnose the condition as something such as a hernia.
The symptom that is the most common is hydrocele. Hydrocele is a buildup of fluid in the scrotum. Sometimes men might notice an abnormal lump in the scrotum itself, or there may be pain and swelling in the testicles. The long latency period of mesothelioma makes it even more difficult to diagnose. The latency period can be between 20 and 50 years.
It is usually during surgery that testicular mesothelioma is diagnosed properly. The process of diagnosis begins with a physical examination followed by an ultrasound. Ultrasounds are 90 percent effective in detecting testicular tumors. Once a tumor is seen on an ultrasound, a CT scan is performed to determine what stage the mesothelioma is in and whether or not it has spread.
For confirmation that the tumor is testicular mesothelioma, a blood sample is collected and tested. Doctors look for certain mesothelioma markers such as claretinin, cytokeratin 5/6 and WT1 or Wilms tumor gene 1.
Testicular mesothelioma may also be accurately confirmed by performing a biopsy. A biopsy involves removing tissues from the tumor and then sending it off to the lap for testing. The sample is evaluated with a technique called immunohistochemical staining. This aids the doctors in determining if the tumor is mesothelioma or another condition.
Testicular Mesothelioma Treatment
Typically treatment of testicular mesothelioma involves removing either a portion or all of one testicle, depending on how extensive the cancer is. Radical inguinal orchiectomy is the most effective surgery for localized testicular mesotheliomas that have not yet spread. It removes the affected testicle along with the spermatic chord. If nearby lymph nodes are involved, the doctor will also remove them during surgery. Removal of the lymph nodes is called a lymphadenectomy.
Often chemotherapy follows surgery and patients are given cisplatin and pemetrexed. Following chemotherapy, Radiation therapy is offered to kill off remaining cancer cells and to prevent the cancer from coming back. It is possible, if the cancer has not spread, that neither chemo nor radiation will be necessary after surgery.
There have been a few cases in which the testicular cancer is a secondary tumor with a tumor in the peritoneum being the primary location of the tumor. In these cases the peritoneal mesothelioma will also have to be treated.
- Arango, O. et al (2002). Hemiscrotectomy with contralateral testicular transposition for scrotal cancer. Journal of Urology 168(4 Part 1), 1406-1407. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed?term=Hemiscrotectomy%20with%20contralateral%20testicular%20transposition%20for%20scrotal%20cancer Retrieved 3/25/16.
- Candura, S.M. et al (2008). Malignant Mesothelioma of the Tunica Vaginalis Testis in a Petrochemical Worker Exposed to Asbestos. Anticancer Research, 28, 1365-1368. Retrieved from http://ar.iiarjournals.org/content/28/2B/1365.full.pdf Retrieved 3/25/16.
- Galateau-Sallé (Ed.) (2010). Pathology of Malignant Mesothelioma. London: Springer-Verlag London Limited. Retrieved 3/25/16.
- James Buchanan Brady Urological Institute, Johns Hopkins Medicine (2011). Laparoscopic Retroperitoneal Lymph Node Dissection. Retrieved from http://urology.jhu.edu/MIS/lap_RPLND.php Retrieved 3/25/16.
- Mak, C.W. et al (2004). Malignant mesothelioma of the tunica vaginalis testis. The British Journal of Radiology, 77, 780-781. Retrieved from http://www.birpublications.org/toc/bjr/current Retrieved 3/25/16.
- Mesothelioma Research Foundation of America (2010). Malignant Mesothelioma of the Tunica Vaginalis. Retrieved fromhttp://www.mesorfa.org/about-meso/tunica.php Retrieved 3/25/16.