Journal of Surgical Oncology 2006;94:161

COMMENTARY

For the surgical oncologist, developing a treatmentparadigm for the patient with a very rare tumor can bedifficult. The lack of treatment experience even in referralinstitutions and the absence of comparative or prospectiverandomized series does not allow us to analyze sufficientdata to determine the best method of treatment. We are rele-gated to learn from small series of patients and case reports.

These three cases of mesothelioma of the tunicavaginalis illustrate recognized aspects of this rare tumor.Important observations are: (1) the relatively highprobability of the patient not having localized tumor;(2) the importance of finding excrescences on scrotalultrasound, and (3) the low chance for cure. The authorsalso suggest that the prognosis may be better for thisentity compared to chest mesothelioma because of earlierdiagnosis due to ease of physical exam.

Other non-germ cell malignancies of the testis andadnexa are also difficult to manage due to the rarity of the

tumor and the lack of treatment experience. Such tumorsas adenocarcinoma of the rete testis and malignant sexcord stromal tumors are generally not sensitive to chemo-therapy or radiation, and our bias at Indiana Universityhas been to have a relatively low threshold to proceedwith retroperitoneal lymph node dissection to attemptto improve the chances for cure. Again, whether this isoptimal is difficult to assess since these tumors are veryrare even in our referral population.

The authors are to be congratulated for adding to ourknowledge regarding this rare entity, and caution all of usto consider these uncommon tumors in the differentialdiagnosis of an inguinal or scrotal mass.

Richard FosterDepartment of Urology, Indiana University

Indianapolis, Indiana

Received 23 September 2005; Accepted 29 September 2005

DOI 10.1002/jso.20429

Published online in Wiley InterScience (www.interscience.wiley.com).

� 2006 Wiley-Liss, Inc.