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Penis and scrotum
Other malignancies
Mesothelioma (malignant) of scrotum
Editor: Antonio Cubilla, M.D. and Alcides Chaux, M.D. (see Author/Reviewers page)
Revised: 23 May 2010, last major update May 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Microscopic, immunohistochemical and ultrastructural features similar to mesothelioma of pleura
● ICD-O: 9050/3
● See also testis chapter
Terminology
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● Benign scrotal / paratesticular mesothelial lesions include mesothelial cyst, reactive mesothelial hyperplasia, adenomatoid tumor, benign cystic mesothelioma and benign papillary mesothelioma
Epidemiology
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● Exceedingly rare (less common than tumors of pleura and peritoneum)
● Most occur between ages 55-75 years
Etiology
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● Arises from mesothelial cells that line tunica vaginalis or tunica albuginea
● Asbestos exposure in <50%
Clinical features
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● Often resembles a hydrocele
● May have coexisting pleural or peritoneal tumors
● Very aggressive - infiltrates adjacent tissue or metastasizes to retroperitoneal lymph nodes
Case reports
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● 21 year old man with bilateral tumors one year apart (Urology 2004;64:1031)
● 42 year old man with multiple recurrences and death due to disease (Hinyokika Kiyo 2008;54:619)
● 67 year old man with asbestos related tumor (Int J Urol 2008;15:560)
Gross description (Macroscopy)
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● Thickening of tunica vaginalis with multiple nodules
● Variable involvement of tunica albuginea
Gross images
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Multiple soft tissue nodules
Tunica vaginalis is diffusely thickened by
white tumor extending irregularly into
adjacent epididymis and surrounding
soft tissue. AFIP image from Ro, et. al.,
Atlas of Surgical Pathology of the male
reproductive tract, Sanders, 1977
Micro description
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● Usually epithelioid, pure sarcomatoid is rare
● Patterns are papillary, tubular or solid
Micro images
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In situ lesion of tunica vaginalis
Invasion of testis is present
Positive stains
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● Calretinin, EMA, thrombomodulin, CK7
● CK5/6 is usually positive but varies in strength and distribution (Am J Surg Pathol 2006;30:1)
Negative stains
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● CK20, CEA, BerEP4 (occasionally is focal/weak)
Electron microscopy
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● Long, thin microvilli
Electron microscopy images
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Long, thin surface microvilli, preservation of basal lamina, marked nuclear pleomorphism
End of Penis and scrotum > Other malignancies > Mesothelioma of scrotum
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