When a hydrocele is more than a hydrocele: Warning symptoms and signs of malignant mesothelioma of the tunica vaginalis testis.

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare tumor with no pathognomonic features. It most often presents as a hydrocele. Preoperative assessment, surgical management and prognosis of MMTVT are different than that of a hydrocele. When MMTVT is not suspected and a transcrotal hydrocelectomy is performed, the latter predisposes to tumor cell seeding, increases the risk of tumor recurrence, and decreases the patient's life survival. Therefore, it is prudent for physicians to identify warning symptoms and signs of MMTVT so that they can identify when a hydrocele is more than a hydrocele.