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Malignant Spermatic Cord Mesothelioma

Marta Fajardo-Paneque, Antonio Talegón-Meléndez , Rainiero Ávila-Polo and Francisco José Castell-Monsalve

We report a case of a 71 year old man who presents to our hospital with a non-painful enlargement of the right testicle and an indurated area over the testis. The patient has a working history of asbestos exposure. Scrotal sonography shows a right hydrocele and a heterogeneous mass at the right spermatic cord. Abdominal CT scan confirms the presence of a supratesticular oval mass of 14.5 × 4.7 cm which reaches the inguinal canal and seems to depend on the spermatic cord.

The patient undergoes right orchyectomy. Histological examination shows an infiltrating malignant papillary spermatic cord mesothelioma.

CT scan reveals signs of right pleural mesothelioma with ipsilateral pleural effusion, pleural implants, multiple lymphadenopathies and an anterior pneumothorax. A pleural biopsy reveals the presence of malignant epithelioid mesothelioma.

The comparison of both neoplasms hints at a similarity in their immunohistochemical profile and morphology. The patient receives first line chemotherapy with six cycles of cisplatin/pemetrexed, having obtained a maintained partial response and an illness progression-free interval of 3 months. However, in the last CT scan, one-two interaortocaval lymph nodes are detected, which were not previously evidenced, so active surveillance is maintained.