Malignant Mesothelioma of the Spermatic Cord – A Rare and Aggressive Entity

Abstract

Malignant mesothelioma is an uncommon, aggressive neoplasm that develops from cells of the mesothelium, the protective lining that covers many internal organs in the body. As of 2013, only 10 spermatic cord cases were reported in the English literature. Here we report a recent case of this exceptionally rare entity.  A 66-year-old man presented with a 3-month history of an enlarging mass in the left inguinal area, and associated pain with straining and physical exertion. Radiologic studies revealed an oval mass in the left inguinal canal, as well as a left inguinal hernia. After surgical resection, the mass was found to be 9 × 5 × 5-cm, firm, fusiform, pink-tan, and surrounded by an ill-defined tan capsule. Sectioning revealed tan cut surfaces with variegated pale yellow and hemorrhagic regions. Microscopic sections showed a partially necrotic, high-grade malignant neoplasm, which infiltrated fat, muscle, and perineural spaces. It abutted the vas deferens but did not invade. The neoplasm had a biphasic appearance and was composed of spindled and epithelioid cells. Mitotic figures were abundant. Immunostaining showed expression of calretinin and positivity for multikeratins in the epithelioid areas, confirming the diagnosis of spermatic cord malignant mesothelioma. These tumors are usually diagnosed at advanced stages and have a poor prognosis. Radical excision is the primary therapy in localized disease cases. Spermatic cord MMs show recurrence rates of up to 57% within 2 years. The most important prognostic indicator is the age of the patient.

[N A J Med Sci. 2016;9(2):71-74.   DOI:  10.7156/najms.2016.0902071]