Inguinal recurrence of malignant mesothelioma of the tunica vaginalis: one case report with delayed recurrence and review of the literature.

I am Giovanni Liguori, from Department of Urology, University of Trieste, Italy. We wrtite to you to discuss the malignant mesothelioma of the tunica vaginalis. Malignant mesothelioma most often involves the pleural or peritoneal cavity and exposure to asbestos is a wellknown risk factor for its development [1]. Most patients seek medical attention after they note a scrotal swelling during the course of several months. On clinical assessment, these tumours are often believed to represent a hydrocele or epididymal cyst. As a result, most patients are initially treated conservatively for a suspected benign entity and the diagnosis of malignancy is often made postoperatively. In October 2005, a 68-year-old male sought our attention after having developed a nontender subcutaneous left inguinal mass. In June 2000, the patient had undergone, in another institution, trans-scrotal surgical excision of a 1.5-cm painless left epididymal mass that, at histopathological evaluation, resulted in the diagnosis of malignant mesothelioma. The patient underwent no further treatment at that stage and in June 2002 presented to the same department with a left testicular mass of 5 × 7 cm that was managed by left radical orchiectomy and excision of the previous scrotal scar. Histopathological evaluation of the mass showed a diffuse infiltration of the tunica vaginalis and scrotal scar by malignant mesothelioma. When the patient came to our attention, physical evaluation revealed an inguinal lesion of 3-cm diameter located underneath the orchiectomy scar that was firmly stuck to the skin. Suspecting the recurrence of mesothelioma, we performed a radical excision of the lesion and surrounding scar/connective tissue and of an isle of overlying skin. Histopathological examination showed malignant mesothelioma. At immunohistochemical study calretinin and cytokeratin 5,6 were positive, while carcinoembryonic antigen was negative. No adjuvant radiation therapy or chemotherapy were administered, and the patient commenced a strict follow-up that con-