Well-differentiated papillary mesothelioma occurring in the tunica vaginalis of the testis with contralateral atypical mesothelial hyperplasia

Well-differentiated papillary mesothelioma (WDPM) occurs rarely in the paratesticular region, with only a handful of published case reports. Often presenting with recurrent hydrocele, WDPM is a multifocal mesothelial proliferation with a predominantly indolent clinical course. Accordingly, pathologic distinction of this lesion from true malignant mesothelioma is crucial, although it may be difficult because of the variability of associated histologic features. In addition, rare cases of WDPM have progressed to malignant mesothelioma, leading to its classification as a tumor of low malignant potential. Here, we report a case of multifocal WDPM occurring in the tunica vaginalis and tunica albuginea, with contralateral atypical mesothelial hyperplasia, a potentially premalignant lesion.