ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Mesothelioma of the Tunica Vaginalis: An Extremely Rare Cause of Metastatic Pulmonary Nodules
Session Title
TP135 - TP135 THORACIC ONCOLOGY: MALIGNANT PLEURAL DISEASE
Abstract
A4759 - Mesothelioma of the Tunica Vaginalis: An Extremely Rare Cause of Metastatic Pulmonary Nodules
Author Block: H. Freeman1, T. Myers1, B. Moulton1, A. Chen2; 1Department of Medicine, Oregon Health & Science University, Portland, OR, United States, 2Department of Pathology, Oregon Health & Science University, Portland, OR, United States.
Mesothelioma of the tunica vaginalis is an extremely rare malignancy, comprising less than 1% of all mesotheliomas. The National Cancer Institute’s database identified a total of only 113 cases between 1973 and 2015. It occurs most commonly between the sixth and eighth decades of life, although 10% of cases occur in patients under age 25. Asbestos exposure is a well-known risk factor for the development of pleural and peritoneal mesothelioma, but its role in mesothelioma arising from the pericardium and tunica vaginalis has not been well established. Other potential risk factors include scrotal trauma, chronic hydrocele, and hernia repair.
A 79 year-old male with no known asbestos exposure developed right testicular swelling following a mechanical fall. He was found to have a right hydrocele and underwent hydrocelectomy. On subsequent follow up, he was noted to have a remaining hard mass on his right testicle. Testicular tumor markers were negative (AFP 3.5, beta-hCG <2). Imaging revealed a solid testicular tumor with right inguinal lymphadenopathy. He underwent right radical orchiectomy with findings demonstrating a malignant mesothelioma measuring 7cm, composed of biphasic cell type and involving the tunica vaginalis, epididymis, right testes, and adipose tissues. Surveillance PET scan later revealed an FDG-avid soft tissue nodule in the scrotum and right inguinal lymph nodes, concerning for recurrent malignancy. Subsequent CT scan to evaluate for metastatic disease showed two pulmonary nodules within the right upper lobe, prompting navigational bronchoscopy. Biopsy results revealed tumor cells with abundant, "hard" cytoplasm and central to eccentric nuclei, with stromal invasion (figure). Immunohistochemistry markers were positive for CK/6, WT-1, and HBME1, and negative for TTF-1, p63, and D2-40, consistent with metastatic malignant mesothelioma.
This case presents an example of an extremely rare and aggressive neoplasm, one that is often associated with a poor prognosis. Since there are no characteristic clinical symptoms or tumor markers available, the majority of cases are diagnosed intraoperatively and often incidentally. Approximately one third of tumors are locally invasive when diagnosed and more than half of patients develop local or distant recurrence. Biphasic and sarcomatoid cell types are associated with worse overall survival compared to epithelioid. The most common metastatic sites include inguinal and retroperitoneal lymph nodes as well as the lung parenchyma. It is important to be aware of this type of malignancy when evaluating a patient with metastatic pulmonary nodules and a solid testicular mass.
Author Block: H. Freeman1, T. Myers1, B. Moulton1, A. Chen2; 1Department of Medicine, Oregon Health & Science University, Portland, OR, United States, 2Department of Pathology, Oregon Health & Science University, Portland, OR, United States.
Mesothelioma of the tunica vaginalis is an extremely rare malignancy, comprising less than 1% of all mesotheliomas. The National Cancer Institute’s database identified a total of only 113 cases between 1973 and 2015. It occurs most commonly between the sixth and eighth decades of life, although 10% of cases occur in patients under age 25. Asbestos exposure is a well-known risk factor for the development of pleural and peritoneal mesothelioma, but its role in mesothelioma arising from the pericardium and tunica vaginalis has not been well established. Other potential risk factors include scrotal trauma, chronic hydrocele, and hernia repair.
A 79 year-old male with no known asbestos exposure developed right testicular swelling following a mechanical fall. He was found to have a right hydrocele and underwent hydrocelectomy. On subsequent follow up, he was noted to have a remaining hard mass on his right testicle. Testicular tumor markers were negative (AFP 3.5, beta-hCG <2). Imaging revealed a solid testicular tumor with right inguinal lymphadenopathy. He underwent right radical orchiectomy with findings demonstrating a malignant mesothelioma measuring 7cm, composed of biphasic cell type and involving the tunica vaginalis, epididymis, right testes, and adipose tissues. Surveillance PET scan later revealed an FDG-avid soft tissue nodule in the scrotum and right inguinal lymph nodes, concerning for recurrent malignancy. Subsequent CT scan to evaluate for metastatic disease showed two pulmonary nodules within the right upper lobe, prompting navigational bronchoscopy. Biopsy results revealed tumor cells with abundant, "hard" cytoplasm and central to eccentric nuclei, with stromal invasion (figure). Immunohistochemistry markers were positive for CK/6, WT-1, and HBME1, and negative for TTF-1, p63, and D2-40, consistent with metastatic malignant mesothelioma.
This case presents an example of an extremely rare and aggressive neoplasm, one that is often associated with a poor prognosis. Since there are no characteristic clinical symptoms or tumor markers available, the majority of cases are diagnosed intraoperatively and often incidentally. Approximately one third of tumors are locally invasive when diagnosed and more than half of patients develop local or distant recurrence. Biphasic and sarcomatoid cell types are associated with worse overall survival compared to epithelioid. The most common metastatic sites include inguinal and retroperitoneal lymph nodes as well as the lung parenchyma. It is important to be aware of this type of malignancy when evaluating a patient with metastatic pulmonary nodules and a solid testicular mass.
