Positive staining for cytokeratin and vimentin together with negative staining for carcinoembryonic antigen, Leu-M1, epithelial membrane antigen and factor Vlll related antigen is strongly supportive of the diagnosis of mesothelioma. If not carried out preoperatively, CT scans of the pelvis, abdomen and chest can be performed postoperatively for staging. The tumour is frequently locally invasive involving the spermatic cord and adjacent testis. 3 Metastatic spread occurs early via the lymphatic system with retroperitoneal nodes being the most common site of metastases. The tumour spreads less commonly via the bloodstream to the liver and lungs.
Surgery offers the only hope of cure.
The testis with its coverings and the spermatic cord should be excised through an inguinal approach. If previous transcrotal surgery has been performed, hemiscrotectomy should be performed because of the high risk of local recurrence. Some surgeons advocate a more aggressive approach, combining pelvic lymphadenectomy with radical inguinal orchidectomy. If these nodes are positive, a formal retroperitoneal node dissection is then performed. 4 Others recommend orchidectomy followed by local radiation or adjuvant chemotherapy to avoid recurrence.