www.kjurology.org DOI:10.4111/kju.2011.52.3.225 Case Report Malignant Mesothelioma of the Spermatic Cord Yoo Jun Park, Hyuk Jun Kong, Hyun Chan Jang, Hong Seok Shin, Hoon Kyu Oh1, Jae Shin Park Departments of Urology and 1Pathology, Catholic University of Daegu, School of Medicine, Daegu, Korea Primary tumors arising from the spermatic cord are very rare. Mesothelioma derives from the mesothelial cells lining the serous membrane, such as the pleura, peritoneum, and tunica vaginalis of testis. Paratesticular malignant mesothelioma (MM), which usually presents as a hydrocele or intrascrotal mass, accounts for 0.3% to 1.4% of MMs. MMs of the spermatic cord account for less than 10% of paratesticular MMs. We report a case of MM of the spermatic cord in a 65-year-old man who primarily presented to the hospital with a left inguinal mass. Following the diagnosis after surgery, he was found to have a contralateral right inguinal mass and died in 6 months. Despite their rare occurrence in the spermatic cord, MMs need to be suspected, especially in patients with a history of asbestos exposure. Key Words: Mesothelioma; Spermatic cord; Testis This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Article History: received 11 November, 2010 accepted 31 December, 2010 Corresponding Author: Jae Shin Park Department of Urology, Catholic University of Daegu, School of Medicine, 3056-6, Daemyeong 4-dong, Daegu 705-718, Korea TEL: +82-53-650-4662 FAX: +82-53-623-4660 E-mail: jspark@cu.ac.kr Malignant mesothelioma (MM) derives from the meso- thelial cells lining serous membranes, such as the pleura, peritoneum, and tunica vaginalis of testis. Paratesticular MM, which usually presents as a hydrocele or intrascrotal mass, accounts for 0.3% to 1.4% of MMs [1]. Around 35% to 40% of patients have a history of direct occupational or familial asbestos exposure [2]. This tumor rarely presents as a spermatic cord mass, and only about 10 cases have been reported in the past [3]. Here we report a case of a patient diagnosed with MM arising from the spermatic cord. The diagnosis was followed by the patient’s death in 6 months. CASE REPORT A 65-year-old man presented to our outpatient department with a painless, palpable mass in his left inguinal area that had persisted for 2 months. The mass was insidious in onset and had increased gradually in size. He had no bowel or bladder symptoms and no history of previous surgery or trauma to the region. He did have a history of 4 years of em- ployment at a foundry job 10 years previously; thus, he had been exposed to asbestos for a duration of 4 years. 　On the physical examination, a 3x3 cm mass was pal- pated in his left inguinal area. The mass was hard, globular, smooth, and nontender, and the lower margins were not palpable below the inguinal ligament. A hard spermatic Korean Journal of Urology Ⓒ The Korean Urological Association, 2011 cord was palpated. The scrotum was normal except for a sli- ghtly enlarged, nontender left testis. The laboratory exami- nations showed a normal complete blood count and normal renal and liver functions. Alpha fetoprotein was 3.07 ng/ml (normal ＜20 ng/ml) and the beta human chorionic gonado- tropin level was 1.20 mIU/ml (normal ＜5 mIU/ml). The re- sults of a chest X-ray and following chest CT were normal. Ultrasound examination of the abdomen and scrotum showed a 3.0x3.3x1.8 cm nodal mass in the left inguinal area. The right testis was 3.0x2.2x4.9 cm in size, whereas the left testis was enlarged to 3.3x2.7x4.9 cm, contained a little hydrocele, and had normal echogenicity and vascula- rity. Computed tomography (CT) of the abdomen showed a left inguinal mass and bilateral small renal cysts but no abnormalities in other intraabdominal organs (Fig. 1). 　The patient underwent left radical orchiectomy. At the peritoneal surface of the internal inguinal ring, three small nodular masses were noted and excised. Grossly, the left orchiectomized specimen was composed of a 5.0x6.0 cm tes- tis attached to a 12 cm length spermatic cord and a detached tunica vaginalis hydrocele sac. At the spermatic cord, there was a nodular mass measuring 5.0x3.2x2.5 cm. The outer surface of the mass was relatively well capsulated and the cut surface had a shiny white color. The testis architecture was well preserved (Fig. 2). The excised nodular tissues at the internal ring were measured 1.5x1.0x0.3 cm in the 225 Korean J Urol 2011;52:225-229