Objective
To describe clinical management and outcomes of a cohort of patients with malignant
mesothelioma of the tunica vaginalis testis (MMTVT) who received treatments beyond
radical orchiectomy.
Methods
Patients with confirmed MMTVT at a single tertiary care institution were identified.
Treatments, pathologic outcomes, and survival were recorded. Prognostic variables
associated with survival were analyzed with a Cox proportional hazards model and Kaplan-Meier
curves.
Results
Overall, 15 patients were included. Initial presentation was a scrotal mass in 7 of
15 (47%) and hydrocele in 5 of 15 (33%) patients. Clinical staging revealed enlarged
nodes in 5 of 15 (33%) patients. Radical orchiectomy was the initial treatment in
5 of 15 (33%) patients. Positive surgical margins were found in 6 of 14 (43%) radical
orchiectomies and were associated with worse survival (P = .007). The most frequent histologic subtype was epithelioid, associated with better
survival (P = .048). Additional surgeries were performed on 12 of 15 (80%) patients. Pathologic
examination revealed MMTVT in 6 of 12 (50%) hemiscrotectomies, 7 of 8 (88%) retroperitoneal
lymph node dissections, 1 of 7 (14%) pelvic lymph node dissections, and 10 of 10 (100%)
groin dissections. Five patients received adjuvant chemotherapy. Two also received
adjuvant radiation therapy. Three patients with lymph node involvement remain no evidence
of disease over 6 years after diagnosis. After a median follow-up of 3.5 years (interquartile
range: 1.2-7.2), 5 patients have died, all of MMTVT; the median overall survival has
not been reached. Common sites of relapse were lungs (5 of 7) and groin (3 of 7).
Conclusion
The pattern of metastatic spread of MMTVT is predominantly lymphatic. Nodes in the
retroperitoneum and the groin are commonly involved. Prognosis is poor, but there
may be a role for aggressive surgical resection including hemiscrotectomy, and inguinal
and retroperitoneal lymph nodes.
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Article info
Publication history
Published online: April 14, 2017
Accepted:
April 6,
2017
Received:
February 10,
2017
Footnotes
IRB: The data used in this study were reviewed by the IRB and granted a Waiver of Authorization determined to be exempt from human subject research consent requirement.
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: The Sidney Kimmel Center for Prostate and Urologic Cancers; funds provided by David H. Koch through theProstate Cancer Foundation; NIH/NCI Cancer Center Support Grant to MSKCC under award number P30 CA008748; and the Richard Capri Foundation.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
