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Presented by Dr. Andres Matoso and prepared by Dr. Harsimar Kaur
34 yo male with hydrocele.
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1. Question
34 yo male with hydrocele.
Correct
Correct answer: C.
Histology: The fibrous wall of this hydrocele sac is hyalinized and thickened and smal tubules or clusters of epithelioid cells arranged linearly and paralell to the mesothelial surface.
Discussion: The tunica vaginalis is an embryologically derived mesothelium-lined outpouching of the peritoneal cavity, which may develop neoplastic mesothelial proliferations similar to pleural or peritoneal surfaces. In contrast to the normal tunica consisting of a thin fibrous wall lined by a monolayer of flattened bland mesothelium and no significant inflammation, this case is characterized by background changes of fibroblastic organization and stromal chronic inflammation. The mesothelial proliferation within the fibrous stroma consists of linear arrays of widely spaced horizontally elongated tubules and small solid nests and cords that were well spaced apart. The entrapment of isolated mesothelial clusters within deep fibrous tissue may be the cause of significant diagnostic difficulty. However, morphologic clues such as linear arraying of widely spaced architecturally simple cell clusters that may aid in the correct identification of the benignity of these proliferations.
References:
1. Lee S, Illei PB, Han JS, Epstein JI. Florid mesothelial hyperplasia of the tunica vaginalis mimicking malignant mesothelioma: a clinicopathologic study of 12 cases. Am J Surg Pathol. 2014 Jan;38(1):54-9.Incorrect
Correct answer: C.
Histology: The fibrous wall of this hydrocele sac is hyalinized and thickened and smal tubules or clusters of epithelioid cells arranged linearly and paralell to the mesothelial surface.
Discussion: The tunica vaginalis is an embryologically derived mesothelium-lined outpouching of the peritoneal cavity, which may develop neoplastic mesothelial proliferations similar to pleural or peritoneal surfaces. In contrast to the normal tunica consisting of a thin fibrous wall lined by a monolayer of flattened bland mesothelium and no significant inflammation, this case is characterized by background changes of fibroblastic organization and stromal chronic inflammation. The mesothelial proliferation within the fibrous stroma consists of linear arrays of widely spaced horizontally elongated tubules and small solid nests and cords that were well spaced apart. The entrapment of isolated mesothelial clusters within deep fibrous tissue may be the cause of significant diagnostic difficulty. However, morphologic clues such as linear arraying of widely spaced architecturally simple cell clusters that may aid in the correct identification of the benignity of these proliferations.
References:
1. Lee S, Illei PB, Han JS, Epstein JI. Florid mesothelial hyperplasia of the tunica vaginalis mimicking malignant mesothelioma: a clinicopathologic study of 12 cases. Am J Surg Pathol. 2014 Jan;38(1):54-9.
