Testicular mesothelioma is a very rare form of asbestos cancer which occurs in the tunica vaginalis which is the membrane or lining around the testes. In fact, it is the rarest form of mesothelioma. To date, there have been approximately 223 diagnosed and described cases of testicular mesothelioma, though it’s possible there are more that were not diagnosed due to lack of awareness of this particular disease. 1 As a matter of fact, most research in this area is based on patient case reports and reviews of cases in which the patients have died.2 With a long latency period and few symptoms, testicular mesothelioma is usually not diagnosed until it is in the late stages when it is difficult to treat and the prognosis is not good.
What is the Tunica Vaginalis?
The tunica vaginalis is a thin membrane that surrounds the testes within the testicles. The purpose of the membrane is to protect the sensitive reproductive organ components and to provide support for the testes. There are two layers to the tunica vaginalis: the visceral lamina and the parietal lamina. Fluid is secreted between these two layers in order to lubricate and protect the testes.
Most testicular tumors due to testicular mesothelioma are found in the germinal epithelium or the innermost testicle layer. Sometimes, the tumors will form in other areas including the lymphoid, ductal or interstitial sections. Testicular mesothelioma has also been diagnosed in the paratesticular tissue.3 The paratesticular region includes the spermatic cord, the testicular tunics and the collection system. In other words, in theory the testicular tumors can form anywhere in the testicles.
What Causes Testicular Mesothelioma?
Testicular mesothelioma is believed to be caused from asbestos exposure. However, because the disease is so rare, researchers are not exactly sure if it is only asbestos that is the culprit or if there are other causes. They are also unsure of the definitive process which explains how asbestos exposure leads to testicular mesothelioma, including how asbestos fibers are able to reach the testicular lining. In some cases, testicular mesothelioma may be a secondary cancer caused from peritoneal mesothelioma.
What is known is that once asbestos fibers enter the body, they can embed themselves in any membrane or organ that can be reached. Once lodged, they can cause inflammation leading to eventual cell mutations. It may take years before detected and in the meantime there may be a buildup of fluid or the growth of tumors. In testicular mesothelioma, cancer cells lead to a thickening of the tunica vaginalis. That thickening can then lead to tumor development.
Testicular Mesothelioma Symptoms and Diagnosis
The normal presenting symptoms of testicular mesothelioma appear to be a mass or lump within the testicles or testicular swelling. Testicular swelling may be due to hydrocele which is a fluid filled sack in the scrotum that is connected to the spermatic cord.4 These symptoms often go undiagnosed or are misdiagnosed. In some cases, a patient is undergoing surgery for an unrelated medical condition and the surgeon notes the presence of a suspicious mass. In that case, it is common practice to take a tissue sample for testing at the time of the surgery. In one case, testicular mesothelioma was only diagnosed when the patient was undergoing surgery for a hernia. If abnormalities are suspected in the testes, then a doctor will take a biopsy from the testes for analysis.
Well-differentiated papillary mesotheliomas seldom involve the testis tunica vaginalis, yet there are case studies involving paratesticular mesotheliomas. Researchers are studying these cases to determine if the papillary mesotheliomas can be used as an indicator of malignant potential.5 Studies so far are inconclusive which gives you an idea of the complexity and lack of knowledge in the testicular mesothelioma research area.
After Testicular Mesothelioma Diagnosis
Testicular mesothelioma is usually very aggressive and spreads quickly. Thus, prognosis is dim for patients diagnosed with testicular mesothelioma. The primary method of diagnosis is an operative procedure followed by pathology analysis. These cases are seldom diagnosed correctly without surgery.
Treatment usually involves surgical removal of the infected area of the testicle or the entire testicle. It is often recommended that surgery be followed up with radiation or chemotherapy in order to ensure all cancerous cells are destroyed. If the testicular mesothelioma is secondary to peritoneal mesothelioma, then more aggressive forms of treatment will be needed in order to control the cancer growth. Peritoneal mesothelioma is where the primary tumor is located within the peritoneum or the abdominal cavity lining. When it is the primary tumor and testicular mesothelioma has been diagnosed, the cancer has metastasized or spread. This requires more aggressive treatment to prolong life.
As a victim of asbestos exposure who has been diagnosed with testicular mesothelioma, you may be entitled to compensation. There are a number of funds set up to compensate those who develop cancer due to asbestos exposure. You should consult with an experienced mesothelioma lawyer to see what compensation you are eligible to receive. While financial compensation does not cure mesothelioma, it can be a valuable resource during treatment and provide for your family in the future.
References
1 Bisceglia, M., Dor D. B., Carosi, I. , Vairo, M. and Pasquinelli, G., (Jan 2010) Paratesticular mesothelioma. Report of a case with comprehensive review of literature. Adv Anat Pathology. V1: 53-70)
2 Murthy, V., Fisher, C. and Horwich, A. (2006) Rare Tumors of the Testis and Paratesticular Tissues, in Textbook of Uncommon Cancer, Third Edition (eds D. Raghavan, M. L. Brecher, D. H. Johnson, N. J. Meropol, P. L. Moots, P. G. Rose and I. A. Mayer), John Wiley & Sons, Ltd, Chichester, UK.
3 Ibid
4 Bisceglia, op. cit.
5 Brimo, F., Illei, P. B and Epstein, J. I, (23 August 2010) Mesothelioma of the tunica vaginalis: a series of eight cases with undercertain malignant potential. Mod Pathology v8: 1165-72.