image: This figure outlines diagnostic and management consensus of MMTVT, including 4 key modules: the screening, diagnosis, treatment, follow-up. (1) Screening: For those aged 60-80 (mainly), with asbestos exposure/ living in high-risk areas, and symptoms like hydrocele, conduct MMTVT-specific assessments to rule out malignancy; (2)Diagnosis: US (first choice) for screening; CT/MRI for tumor extent; PET/CT for staging/response. Histopathology (with ≥3 mesothelial markers) is gold standard. Sequencing for recurrent cases’ mechanism; multidisciplinary consultation to reduce misdiagnosis; (3)Treatment:Radical inguinal orchiectomy for localized lesions (no contraindications);prioritize surgery for recurrence. High-risk patients need enhanced follow-up.Individualized postoperative chemoradiotherapy (adjust first-line regimens/dosages as needed); (4) Follow-up: Every 3 months (first 2 years), yearly (years 2-5); lifelong monitoring (due to late recurrence risk). Multidisciplinary collaboration + individualized management improve prognosis. Abbreviation MMTVT, Malignant Mesothelioma of the Tunica Vaginalis Testis; US, Ultrasonography; CT, Computed tomography; MRI, magnetic resonance imaging;
Credit: Yiqing Cai , Chunwei Xu , Jing Lin,Qian Wang,Wenxian Wang,Zhenying Guo ,Enyong Dai,Yuanzhi Lu,Yu Chen
MMTVT, originating from testicular tunica vaginalis mesothelial cells, has a global incidence of 0.54–0.95 per 10 million person-years. Most patients are incidentally diagnosed during surgeries for hydrocele or inguinal hernia, with a preoperative misdiagnosis rate exceeding 95%. Asbestos exposure—with a 20–40-year latency period—is a major risk factor, particularly among workers in mining, construction, and shipbuilding. High-risk regions in China include Dayao County (Yunnan) and Yuyao/Cixi (Zhejiang) due to long-term asbestos exposure.To address the lack of standardized protocols, CHARM led a multidisciplinary team to develop the consensus, marking a milestone in China’s rare disease management.With a median overall survival of 23–35 months, MMTVT has a poor prognosis, especially for patients with primary metastasis. The consensus shifts clinical practice from empirical treatment to evidence-based, personalized care. CHARM plans to update the consensus with ongoing clinical data and emerging therapies, while strengthening high-risk population screening and public awareness.
Method of Research
Commentary/editorial
Subject of Research
Not applicable
Article Title
Expert Consensus on the Diagnosis and Treatment of Malignant Mesothelioma of the Tunica Vaginalis Testis
Article Publication Date
28-Jul-2025
COI Statement
No potential conflict of interest was reported by the authors.