{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T14:30:29Z","timestamp":1788877829419,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Insurance Against Accidents at Work (INAIL: Istituto Nazionale per l\u2019Assicurazione contro gli Infortuni sul Lavoro)","award":["PB-0184"],"award-info":[{"award-number":["PB-0184"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Mesothelioma of the tunica vaginalis testis (MTVT) is an exceedingly rare tumor. We performed a registry-based study on MTVT patient management and survival in Italy. Methods: Cases were extracted from the dataset of the Italian National Mesothelioma Registry. A descriptive analysis of patient characteristics, including asbestos exposure, clinical presentation, diagnostic work-up and therapeutic management, was performed. Overall survival was evaluated. We calculated hazard ratios (HR) and 95% confidence intervals (CI) for selected variables by fitting univariate and multivariable Cox models. Results: Overall, 104 patients with MTVT were included. Median age was 72 years (range 17\u201392). Epithelioid histotype was the most frequent. Previous asbestos exposure was identified in two thirds of cases. Data on diagnostic and therapeutic management were available for 74 patients (71%). The most frequent presentations were scrotal swelling\/mass, hydrocele and inguinal pain. All patients underwent surgery, mostly with orchi-funicolectomy. Adjuvant therapy was administered to 15 patients (20%). Overall median survival was 26.2 months (95% CI 22.1\u201352.1); 3-, 5- and 10-year survival was 49%, 30% and 18%. Older age at diagnosis and presence of distant metastasis (HR 1.91, CI: 0.85\u20134.26) were negative prognostic factors. Adjuvant therapy was associated with higher mortality (HR 2.54, CI: 1.25\u20135.15), indicating a more advanced stage at diagnosis. Conclusions: Surgery remains the mainstay of treatment for MTVT; adjuvant therapy in our study did not improve outcome. Data from cancer registries are essential for rare cancers, but they should be integrated routinely with additional diagnostic and therapeutic information.<\/jats:p>","DOI":"10.3390\/cancers17193249","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T10:48:07Z","timestamp":1759834087000},"page":"3249","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diagnostic and Therapeutic Management of Mesothelioma of the Tunica Vaginalis Testis: A Population-Based Study in Italy"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8599-0629","authenticated-orcid":false,"given":"Giovanni Luca","family":"Ceresoli","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Humanitas Gavazzeni Clinic, 24125 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4276-2583","authenticated-orcid":false,"given":"Simona","family":"Stella","sequence":"additional","affiliation":[{"name":"COR Lombardia, Occupational Health Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Dallari","sequence":"additional","affiliation":[{"name":"COR Lombardia, Occupational Health Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Perduri","sequence":"additional","affiliation":[{"name":"COR Mesoteliomi Emilia Romagna, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinzia","family":"Storchi","sequence":"additional","affiliation":[{"name":"COR Mesoteliomi Emilia Romagna, AUSL-IRCCS Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4072-2871","authenticated-orcid":false,"given":"Luigi","family":"Vimercati","sequence":"additional","affiliation":[{"name":"COR Puglia, Section of Occupational Medicine \u201cB. Ramazzini\u201d, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4198-7035","authenticated-orcid":false,"given":"Sara","family":"Piro","sequence":"additional","affiliation":[{"name":"COR Toscana, Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4326-3615","authenticated-orcid":false,"given":"Lucia","family":"Giovannetti","sequence":"additional","affiliation":[{"name":"COR Toscana, Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9939-3398","authenticated-orcid":false,"given":"Ugo","family":"Fedeli","sequence":"additional","affiliation":[{"name":"COR Veneto, Azienda Zero, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5846-1377","authenticated-orcid":false,"given":"Veronica","family":"Casotto","sequence":"additional","affiliation":[{"name":"COR Veneto, Azienda Zero, 35131 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0121-6295","authenticated-orcid":false,"given":"Enrica","family":"Migliore","sequence":"additional","affiliation":[{"name":"COR Piemonte, Cancer Epidemiology Unit, CPO and University of Turin, 10124 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Stura","sequence":"additional","affiliation":[{"name":"COR Piemonte, Cancer Epidemiology Unit, CPO and University of Turin, 10124 Torino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3690-8582","authenticated-orcid":false,"given":"Carlo","family":"Genova","sequence":"additional","affiliation":[{"name":"COR Liguria, Dipartimento di Medicina Interna e Specialit\u00e0 Mediche, Universit\u00e0 Degli Studi di Genova and UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Benfatto","sequence":"additional","affiliation":[{"name":"COR Liguria, Dipartimento di Medicina Interna e Specialit\u00e0 Mediche, Universit\u00e0 Degli Studi di Genova and UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7717-0417","authenticated-orcid":false,"given":"Francesca","family":"Larese Filon","sequence":"additional","affiliation":[{"name":"COR Friuli Venezia Giulia, Clinical Unit of Occupational Medicine, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"D\u2019Agostin","sequence":"additional","affiliation":[{"name":"COR Friuli Venezia Giulia, Clinical Unit of Occupational Medicine, University of Trieste, 34127 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0313-9799","authenticated-orcid":false,"given":"Ilaria","family":"Cozzi","sequence":"additional","affiliation":[{"name":"COR Lazio, Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, 00139 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1213-6602","authenticated-orcid":false,"given":"Italo Francesco","family":"Angelillo","sequence":"additional","affiliation":[{"name":"COR Campania, Dipartimento di Medicina Sperimentale, Universit\u00e0 degli Studi della Campania \u201cLuigi Vanvitelli\u201d, 80138 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"Spata","sequence":"additional","affiliation":[{"name":"COR Sicilia, Cancer Registry ASP Ragusa and Sicily Regional Epidemiological Observatory, 97100 Ragusa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Murano","sequence":"additional","affiliation":[{"name":"COR Bolzano, Azienda Sanitaria dell\u2019Alto Adige, 39100 Bolzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1131-4286","authenticated-orcid":false,"given":"Iolanda","family":"Grappasonni","sequence":"additional","affiliation":[{"name":"COR Marche, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiana","family":"Pascucci","sequence":"additional","affiliation":[{"name":"COR Marche, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Melis","sequence":"additional","affiliation":[{"name":"COR Sardegna, Regional Epidemiological Observatory, 09123 Cagliari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7594-6680","authenticated-orcid":false,"given":"Fabrizio","family":"Stracci","sequence":"additional","affiliation":[{"name":"COR Umbria, Section of Public Health, Department of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9068-2137","authenticated-orcid":false,"given":"Alessandro","family":"Marinaccio","sequence":"additional","affiliation":[{"name":"DIMEILA, Department of Occupational and Environmental Medicine, Epidemiology, Hygiene, National Institute for Insurance against Accidents at Work (INAIL), 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0435-600X","authenticated-orcid":false,"given":"Alessandra","family":"Binazzi","sequence":"additional","affiliation":[{"name":"DIMEILA, Department of Occupational and Environmental Medicine, Epidemiology, Hygiene, National Institute for Insurance against Accidents at Work (INAIL), 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8935-3843","authenticated-orcid":false,"given":"Dario","family":"Consonni","sequence":"additional","affiliation":[{"name":"COR Lombardia, Occupational Health Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9075-3684","authenticated-orcid":false,"given":"Carolina","family":"Mensi","sequence":"additional","affiliation":[{"name":"COR Lombardia, Occupational Health Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S1470-2045(09)70134-2","article-title":"WHO International Agency for Research on Cancer Monograph Working Group. A review of human carcinogens\u2014Part C: Metals, arsenic, dusts, and fibres","volume":"10","author":"Straif","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Stella, S., Ceresoli, G.L., Dallari, B., Barile, R., Maisenti, F., Rugarli, S., Marinaccio, A., Consonni, D., and Mensi, C. (2024). Mesothelioma of the Tunica Vaginalis Testis: Diagnostic and Therapeutic Management. A Comprehensive Review, 1982\u20132024. Cancers, 16.","DOI":"10.3390\/cancers16233956"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1002\/(SICI)1097-0142(19981215)83:12<2437::AID-CNCR6>3.0.CO;2-G","article-title":"Malignant mesothelioma of the tunica vaginalis testis: Review of the literature and assessment of prognostic parameters","volume":"83","author":"Plas","year":"1998","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2671","DOI":"10.1007\/s00432-021-03533-6","article-title":"Clinicopathological characteristics and outcomes in men with mesothelioma of the tunica vaginalis testis: Analysis of published case-series data","volume":"147","author":"Grogg","year":"2021","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e70003","DOI":"10.1002\/imm3.70003","article-title":"Expert Consensus on the Diagnosis and Treatment of Malignant Mesothelioma of the Tunica Vaginalis Testis","volume":"1","author":"Cai","year":"2025","journal-title":"iMetaMed"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.urology.2019.01.009","article-title":"Testicular Mesothelioma: An Analysis of Epidemiology; Patient Outcomes; and Prognostic Factors","volume":"126","author":"Nazemi","year":"2019","journal-title":"Urology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"609","DOI":"10.5271\/sjweh.3895","article-title":"Association between asbestos exposure and pericardial and tunica vaginalis testis malignant mesothelioma: A case-control study and epidemiological remarks","volume":"46","author":"Marinaccio","year":"2020","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/j.mpdhp.2023.02.003","article-title":"Malignant mesothelioma of the tunica vaginalis and epididymis","volume":"29","author":"Dytor","year":"2023","journal-title":"Diagn. Histopathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.urology.2017.04.011","article-title":"Malignant Mesothelioma of the Tunica Vaginalis Testis: Outcomes Following Surgical Management Beyond Radical Orchiectomy","volume":"107","author":"Recabal","year":"2017","journal-title":"Urology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.humpath.2019.07.009","article-title":"Mesothelioma of the tunica vaginalis testis","volume":"92","author":"Butnor","year":"2019","journal-title":"Hum. Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/S0090-4295(03)00673-3","article-title":"Extensive palliative surgery for advanced mesothelioma of the tunica vaginalis","volume":"62","author":"Black","year":"2003","journal-title":"Urology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.amsu.2019.10.012","article-title":"The necessity of a more aggressive initial surgical treatment in patients with mesothelioma of the testicular tunica vaginalis","volume":"47","author":"Brun","year":"2019","journal-title":"Ann. Med. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1200\/JCO.2003.11.136","article-title":"Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma","volume":"21","author":"Vogelzang","year":"2003","journal-title":"J. Clin. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/S0140-6736(20)32714-8","article-title":"First-line nivolumab plus ipilimumab in unresectable malignant pleural mesothelioma (CheckMate 743): A multicentre; randomised; open-label; phase 3 trial","volume":"397","author":"Baas","year":"2021","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1016\/S0140-6736(23)01613-6","article-title":"Pembrolizumab plus chemotherapy versus chemotherapy in untreated advanced pleural mesothelioma in Canada, Italy, and France: A phase 3, open-label, randomised controlled trial","volume":"402","author":"Chu","year":"2023","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ejso.2017.08.018","article-title":"Epidemiology of rare cancers and inequalities in oncologic outcomes","volume":"45","author":"Gatta","year":"2019","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"100861","DOI":"10.1016\/j.lanepe.2024.100861","article-title":"Management of patients with rare adult solid cancers: Objectives and evaluation of European reference networks (ERN) EURACAN","volume":"39","author":"Blay","year":"2024","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Magnani, C., Mensi, C., Binazzi, A., Marsili, D., Grosso, F., Ramos-Bonilla, J.P., Ferrante, D., Migliore, E., Mirabelli, D., and Terracini, B. (2023). The Italian Experience in the Development of Mesothelioma Registries: A Pathway for Other Countries to Address the Negative Legacy of Asbestos. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20020936"},{"key":"ref_19","unstructured":"StataCorp (2023). Stata Statistical Software: Release 18, StataCorp LLC."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1056\/NEJMra1912719","article-title":"Perspectives on the Treatment of Malignant Pleural Mesothelioma","volume":"385","author":"Janes","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1001\/jama.2024.27122","article-title":"Testicular Germ Cell Tumors: A Review","volume":"333","author":"Singla","year":"2025","journal-title":"JAMA"},{"key":"ref_22","first-page":"9752","article-title":"Role of robot-assisted retroperitoneal lymph node dissection in malignant mesothelioma of the tunica vaginalis: Case series and review of the literature","volume":"26","author":"Faraj","year":"2019","journal-title":"Can. J. Urol."},{"key":"ref_23","unstructured":"Lash, T.L., VanderWeele, T.J., Haneuse, S., and Rothman, K.J. (2021). Modern Epidemiology, Lippincott Williams and Wilkins. [4th ed.]."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1097\/PAP.0000000000000371","article-title":"Malignant Mesothelioma of Tunica Vaginalis Testis: Update for 2022","volume":"30","author":"Iczkowski","year":"2023","journal-title":"Adv. Anat. Pathol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/his.14669","article-title":"Molecular and immunohistochemical characterisation of mesothelioma of the tunica vaginalis","volume":"81","author":"Anderson","year":"2022","journal-title":"Histopathology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/PAS.0000000000002185","article-title":"Mesothelioma of Uncertain Malignant Potential (MUMP) of the tunica vaginalis: Proposal for reclassification as \u201cComplex Mesothelial Tumor of the Tunica Vaginalis\u201d","volume":"48","author":"Ding","year":"2024","journal-title":"Am. J. Surg. Pathol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"100706","DOI":"10.1016\/j.modpat.2025.100706","article-title":"Correlation of Histologic Features with Gene Alterations in Pleural Mesothelioma","volume":"38","author":"Fanaroff","year":"2025","journal-title":"Mod. Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e100051","DOI":"10.1200\/EDBK-25-100051","article-title":"Designing Clinical Trials for Patients With Rare Cancers: Connecting the Zebras","volume":"45","author":"Subbiah","year":"2025","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3249\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:50:00Z","timestamp":1760035800000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/19\/3249"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,7]]},"references-count":28,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["cancers17193249"],"URL":"https:\/\/doi.org\/10.3390\/cancers17193249","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,7]]}}}