Most cases of mesothelioma occur around the lungs (pleural) or around the abdomen (peritoneal). However, there are two rare subtypes that can occur. One is found around the testis and the other can be found around the heart. Estimates place each type to less than 50 cases a year.
Testicular Mesothelioma is also called paratesticular or mesothelioma of the tunica vaginalis testis. It is a rare subtype of mesothelioma that involves the testis.
A major risk factor is exposure to asbestos, typically with a long latency between exposure and diagnosis.
The most common symptom is a mass or hydrocele (buildup of fluid) inside the scrotum. Symptoms of testicular mesothelioma may include scrotal problems, pain, and discomfort. Your doctor may use a physical examination, X-ray or other imaging to detect the lesions. An ultrasound may also be used. A biopsy may be performed and the tumor may be examined by a pathologist to determine exactly what type of cancer it is. Pathologists use immunohistochemical staining to help them identify the genetic markers of various cancers.
Treatment of testicular mesothelioma may include surgery followed by radiation therapy and chemotherapy. Recent studies have concluded that surgery may be curative in some cases. For example, in one study, two patients with this disease were treated by radical inguinal orchiectomy where one or both testicles and the spermatic cord are surgically removed. According to their doctors, “Both patients are currently in complete remission.” These doctors go on to say that the use of chemotherapy and radiation therapy may not always be necessary in this type of mesothelioma. However, other studies have concluded that treatment is only curative in early stages.
The mortality rate from testicular mesothelioma has been reported to be 53% over a mean follow-up time of two years. Even with treatment, this tumor has a very poor prognosis with a median survival of about 23 months.
Pericardial Mesothelioma is an extremely rare subtype of the asbestos-caused cancers. The cancer develops within the pericardium, the membrane that surrounds the heart. This membrane actually has two layers: An outer layer called parietal and an inner layer known as visceral.
Primary pericardial malignant mesothelioma is extremely rare with an incidence less than 0.0022%. It comprises 0.7% of all mesothelioma cases. As of 2012, approximately 350 cases of pericardial mesothelioma have been reported in the peer reviewed medical literature.
Due to its rarity and lack of studies, the role of asbestos in pericardial mesothelioma is unclear.
The symptoms of pericardial malignant mesothelioma are usually not specific and may resemble those of other heart conditions. The symptoms may also relate to a fluid buildup around the heart and thickening of the pericardial layers. The symptoms may also be related to constrictive pericarditis, heart attack, or congestive heart failure. Symptoms that have been reported include: heart palpitations or irregular heartbeat (arrhythmia), difficulty breathing, shortness of breath, fatigue and chest pains. If you are experiencing any of these symptoms see your licensed healthcare provider immediately.
Treatment options are limited because the tumors are so close to the heart.
With the exception of a handful of case reports, patients typically pass away within 6-10 months of diagnosis. An example of a longer term survivor is a 59-year-old woman who underwent surgery for malignant pericardial mesothelioma. The tumor was successfully removed with clean surgical margins. The cell type of her mesothelioma was epithelioid. The patient tolerated the operation and chemotherapy without any complications. She remained alive for almost 3 years after surgery.