Hindawi Publishing Corporation Case Reports in Medicine Volume 2012, Article ID 189170, 4 pages doi:10.1155/2012/189170 Case Report Malignant Mesothelioma of the Tunica Vaginalis: Presenting with Intermittent Scrotal Pain and Hydrocele Tarık Esen,1, 2 Omer Acar,2 Kamil Peker,3 Kemal Sarman,3 Ahmet Musaoglu,2 and Ahmet Tefekli2 1 School of Medicine, Koc University, 34450 Istanbul, Turkey 2 Division of Urology, VKF American Hospital, 34365 Istanbul, Turkey 3 Istanbul Pathology Group, 34365 Istanbul, Turkey Correspondence should be addressed to Omer Acar, omer acar @hotmail.com Received 16 May 2012; Revised 22 June 2012; Accepted 1 July 2012 Academic Editor: Bruno Megarbane Copyright © 2012 Tarık Esen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Paratesticular mesotheliomas are very rare tumors. In this paper, we present the management of a 38-year-old male patient with paratesticular malignant mesothelioma who was initially misdiagnosed and treated as recurrent epididymitis. After the ﬁnal pathology report deﬁning paratesticular mesothelioma during scrotal exploration, he underwent radical orchiectomy and hemiscrotal excision as a complementary, secondary procedure. His metastatic workup did not show any dissemination. Therefore, he did not receive any adjuvant treatment and remained disease-free for more than 2 years. 1. Introduction Only a subset of the tumors within the scrotal sac is extrat- esticular. The paratesticular region, including the spermatic cord, testicular tunics, epididymis and vestigial remnants, is composed of a mixture of epithelial, mesothelial, and mes- enchymal elements [1]. With the exception of cystadenomas of the epididymis, occasional dermoid cysts of the spermatic cord and rare papillary tumours, most tumours involving the testicular adnexia are of mesenchymal origin and harbor malignant potential [2, 3]. Herein, we give the clinical details of a patient with para- testicular malignant mesothelioma, who presented with a longstanding history of scrotal pain and swelling and receiv- ed many medications due to the presumptive misdiagnosis of epididymitis before the ﬁnal diagnosis of mesothelioma. 2. Case Report A 38-year-old male patient presented with left testicular pain and swelling. His past medical history was unremarkable. However, he had similar complaints which also included intermittent swelling for almost 1.5 years, and during this period he received many medications for recurrent epididymitis. Previous imaging ﬁndings and serum tumor marker values obtained elsewhere were within normal limits. Phys- ical examination was completely normal on his initial visit in our department, upon which he was recommended to present while he has the scrotal swelling again. The patient represented 1 month later with a signiﬁcant, soft, noninfec- tious swelling on the left hemiscrotum, suggesting reactive hydrocele formation. Left epididymis was minimally dilated and sensitive upon palpation. Scrotal ultrasonography demonstrated ﬁndings related to hydrocele and left epididymitis. Testicular parenchyma was devoid of any ultrasonographic abnormality. Blood and urine tests, including serum tumor markers, were again within normal limits. Based on these ﬁndings, he was scheduled for left hemi- scrotal exploration, during which, inﬂammatory tunical lay- ers together with caput epididymis, which seemed dilated and inﬂamed, were excised and sent to pathology. Postoper- ative course was uneventful. He was discharged the following day. Histopathological examination of the excised specimen revealed normal ﬁndings for epididymis but epitheloid-type