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Imaging of mesothelioma of tunica vaginalis testis

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Abstract

Objectives

To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis.

Methods

We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis.

Results

A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection.

Conclusions

A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity.

Key Points

Mesotheliomas of the tunica vaginalis are rare, often challenging to diagnose preoperatively.

Most common finding is a complex hydrocele with hypervascular parietal vegetations.

Septated hydrocele, nodules without hydrocele, a thick-walled paratesticular cyst are less common.

Preoperative diagnosis may allow aggressive surgical approach and, possibly, a better prognosis.

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Acknowledgments

We thank Dr. Carlo Toncini for his kind help in reviewing the pathological images. The scientific guarantor of this publication is Lorenzo E. Derchi. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, observational, multicenter study.

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Correspondence to Lorenzo E. Derchi.

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Bertolotto, M., Boulay-Coletta, I., Butini, R. et al. Imaging of mesothelioma of tunica vaginalis testis. Eur Radiol 26, 631–638 (2016). https://doi.org/10.1007/s00330-015-3887-9

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  • DOI: https://doi.org/10.1007/s00330-015-3887-9

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