PDF(Pubmed)
Abstract：
Malignant mesothelioma of the testes is an aggressive, yet rare urogenital malignancy, accounting for an infinitesimally small number of oncologic diagnoses. This infrequent occurrence is accompanied by a relative lack of knowledge surrounding this disease, thus limiting management options beyond surgical intervention. Oftentimes, these malignancies present with a poor prognosis despite early intervention and only worsen in the event of metastatic spread with poor survival and limited response to treatment, if any. Our case documents positive patient outcomes following the use of aggressive surgical intervention in the management of a metastatic testicular mesothelioma. A healthy 80-year-old male with sudden painless testicular swelling requiring radical orchidectomy following failed initial conservative management. Pathologically, the specimen was diagnosed as malignant mesothelioma of the right testis with involvement of the tunica albuginea and tunica vaginalis. Following disease recurrence at 82 years of age, the patient subsequently opted for an open right-sided template non-nerve sparing retroperitoneal lymph node dissection which was undertaken without complication. Malignant mesothelioma of the testes remains an ominous diagnosis with historically poor outcomes and for which surgical intervention remains the mainstay of treatment. The retroperitoneal lymphatic drainage represents the most common route of metastatic spread for testicular tumours; however, retroperitoneal lymph node dissection has rarely been employed in this patient population and never in an individual of this age. Our findings contribute to the growing literature surrounding these rare malignancies and outline the importance of considering both patient autonomy and the clinical picture in disease management.
摘要：
睾丸恶性间皮瘤是一种侵袭性的,然而罕见的泌尿生殖系统恶性肿瘤，考虑到无限小的肿瘤诊断。这种罕见的发生伴随着对这种疾病的知识相对缺乏，因此限制了手术干预以外的管理选择。通常,尽管早期干预,但这些恶性肿瘤的预后较差,并且仅在转移扩散的情况下恶化,生存率差,对治疗的反应有限,如果有的话。我们的病例记录了在转移性睾丸间皮瘤的治疗中使用积极的手术干预后患者的积极预后。一位健康的80岁男性，突然出现无痛性睾丸肿胀，在最初的保守治疗失败后需要进行根治性睾丸切除术。病理上,该标本被诊断为右睾丸恶性间皮瘤，累及白膜和阴道膜。在82岁时疾病复发后，患者随后选择了开放式右侧模板非保留神经的腹膜后淋巴结清扫术，该手术没有并发症。睾丸恶性间皮瘤仍然是一个不祥的诊断，具有历史上较差的结果，并且手术干预仍然是治疗的主要手段。腹膜后淋巴引流是睾丸肿瘤转移扩散的最常见途径；然而，腹膜后淋巴结清扫术很少在该患者人群中使用，也从未在该年龄的个体中使用。我们的发现有助于围绕这些罕见恶性肿瘤的越来越多的文献，并概述了在疾病管理中同时考虑患者自主权和临床表现的重要性。
