睪丸鞘膜惡性間皮瘤

任駿逸、吳宗憲

高雄長庚紀念醫院 泌尿科

Malignant Mesothelioma of the Tunica Vaginalis Testis: A Case Report

Chun-Yi Jen, Tsung-Hsien Wu

Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine

Abstract:

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumor. The etiology of malignant genital mesothelioma remains unknown, but asbestos exposure plays an important role. The prognosis of the cancer is poor with high rates of distant metastases and death despite aggressive surgical procedures or systemic adjuvant therapies. Here, we present a rare case of malignant mesothelioma of the tunica vaginalis testis.

A 35-year-old man with no systemic disease was admitted to our hospital because of left scrotal swelling. The patient had been in his usual state of health until approximately 4 weeks before admission, when he reportedly had left scrotal swelling. He came to outpatient department of Urology in our hospital for help. There was no associated fever, chills, scrotal pain, or abdominal pain. Physical examination showed enlarged left testicle with mild tenderness. Testicular sonography demonstrated enlargement and increased vascularity of epididymis, suspect left epididymo-orchitis. Oral levofloxacin 500mg QD was prescribed for 3 weeks with mild regression of abscess on the following testicular sonography. However, the scrotal swelling did not improve much. We then arranged admission with surgical debridement for epididymo-orchitis progressed to testicular abscess formation. CT of pelvis demonstrated a 2.7x3.4x3.3cm enhancing thickened wall lesion in left scrotum with left hydrocele, compatible with our tentative diagnosis. Left epididymectomy with hydrocelectomy was performed uneventfully, but pathology report revealed malignant mesothelioma. After discussion, we then performed left orchiectomy, and there was no residual malignancy in the specimen. The patient will return for outpatient follow-up regularly.