Malignant mesothelioma of the tunica vaginalis testis - Atypical sonographic appearance

Malignant mesothelioma of the tunica vaginalis testis is a rare scrotal neoplasm with fewer than 80 cases reported in the literature in the last 30 years.' Because many of the cases reported did not have ultrasonographic evaluations before surgery, a paucity of literature is available concerning the sonographic appearance of this tumor. Indeed, most of these cases did not have a preoperative diagnosis of malignancy, which had a direct effect on the patients' surgical management and prognoses.(1) The nonspecific symptoms, broad age distribution, and lack of tumor markers make preoperative diagnosis of malignant mesothelioma of the tunica vaginalis difficult.(1.2) With recent advances in technology and improved resolution, ultrasonography may be a useful part of the presurgical workup and may help increase detection of malignancy in these patients. We describe a case of malignant mesothelioma of the tunica vaginalis that appeared as an intratesticular mass and the various sonographic appearances of this tumor.