CONCOMITANT MALIGNANT MESOTHELIOMA OF THE PLEURA, PERITONEUM, AND TUNICA VAGINALIS TESTIS

We describe the cytohistological, immunohistochemical and ultrastructu ral findings in a 55-yr-old-man with history of asbestos exposure and diffuse malignant mesothelioma (DMM) of the pleura, peritoneum, and tu nica vaginalis presenting with chest pain and scrotal swelling. Pleura l fine-needle aspiration (FNA) revealed mesenchymal elements and spind le-shaped epitheliallike cells, while biopsy showed pure sarcomatous t umor invading lung parenchyma. In both samples tumor cells coexpressed cytokeratin and vimentin. Peritoneal and hydrocele effusions containe d aggregates of malignant mesothelial cells. Electron microscopy showe d intermediate filaments, rare desmosomes and sparse microvilli. Morph ological findings were consistent with a DMM, with a biphasic pattern in the pleura and an epithelial one in the peritoneum and tunica vagin alis. Although the possibility of a multicentric origin cannot be rule d out, clinical chronologic sequence suggests that the pleura was the primary involved site, followed by spread to peritoneum and tunica vag inalis. (C) 1996 Wiley-Liss, Inc.