Imaging of mesothelioma of tunica vaginalis testis

• Published in: European radiology 2016-03, Vol.26 (3), p.631-638
• Main Authors: Bertolotto, M., Boulay-Coletta, I., Butini, R., Dudea, S. M., Grenier, N., Oltmanns, G., Ramchandani, P., Stein, M. W., Valentino, M., Derchi, Lorenzo E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Contrast Media; Diagnosis, Differential; Diagnostic Radiology; Follow-Up Studies; Hospitals; Humans; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Mesothelioma; Mesothelioma - blood supply; Mesothelioma - diagnosis; Mesothelioma - diagnostic imaging; Middle Aged; Neuroradiology; Radiology; Retrospective Studies; Survival Rate; Testicular Hydrocele - diagnosis; Testicular Hydrocele - diagnostic imaging; Testicular Neoplasms - blood supply; Testicular Neoplasms - diagnosis; Testicular Neoplasms - diagnostic imaging; Treatment Outcome; Ultrasonography, Doppler, Color - methods; Ultrasound; Urogenital
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-015-3887-9

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 .