A Rare Case of Bilateral Paratesticular Malignant Mesothelioma of Tunica Vaginalis with Bilateral Hydrocele

Paratesticular region is an indeterminate anatomical region including the spermatic cord with its contents- tunica vaginalis of the testes, epididymis and its appendices and testis. Paratesticular tumours may mimic testicular tumours and is clinically indistinguishable. Paratesticular malignant mesothelioma is an extremely rare tumour, representing only 0.3-5% of all mesotheliomas. There is not a specific clinical presentation however, it may present as a mass which is painless or as a hydrocele, having a wide age distribution. Lack of specific tumour markers presents a challenge in its diagnosis and management. Extreme diagnostic difficulty arises preoperatively in distinguishing malignant and benign tumour. Most of the cases are diagnosed intraoperatively or postoperatively when found on biopsy. Pleural and peritoneal mesotheliomas are known to occur in individuals exposed to asbestos. The case reported here is of a 32-year-old male who reported in the Out Patient Department (OPD) with the complaint of painless bilateral enlarged scrotum without history of exposure to asbestos. Bilateral orchidectomy followed by biopsy reported paratesticular malignant mesothelioma. Bilateral malignant mesothelioma of tunica vaginalis with bilateral hydrocele occurrence is rare, and it has an aggressive clinical progression, so clinical presentation and histopathology features are being presented to emphasise on the fact that it is critical for the urologists to be aware of such potentially rare entity. A mandatory high index of clinical suspicion is required, as lack of knowledge would result in an unnecessary radical orchidectomy as happened in present case.