Primary malignant mesothelioma of the tunica vaginalis presenting as hydrocele: imaging pitfalls.
Jatin Naidu, Nikhil G Joseph, Mai Mohammed et al.
✦ AI-curated · Sources linked
Case in brief
A man in his late 70s presented with a progressive, painless scrotal swelling initially diagnosed as a simple hydrocele via ultrasound. During surgery, friable nodules on the tunica vaginalis were biopsied, revealing malignant epithelioid mesothelioma. Staging CT confirmed no pleural or peritoneal disease, indicating a primary origin from the tunica vaginalis.
What made this case unusual
This case is notable for the rare occurrence of primary malignant mesothelioma of the tunica vaginalis, which is typically a site of secondary spread from the peritoneum.
Diagnostic / clinical pearl
Clinicians should maintain a high index of suspicion for malignancy in cases of scrotal swelling, especially when imaging findings do not correlate with intraoperative findings.
Why it matters
This case underscores the limitations of ultrasound in diagnosing scrotal masses and the need for careful evaluation when imaging results are inconsistent with clinical presentation.