Imaging appearance of cystic and solid mesothelioma of the tunica vaginalis

We present the case of a 32-year-old male who presented with a growing scrotal mass initially diagnosed as benign adenomatoid tumor on ultrasound 6 years prior. Repeat ultrasound showed an abnormal extra-testicular mass with nodular and cystic components and internal vascularity. A computed tomography scan of the abdomen and pelvis confirmed a right extra-testicular scrotal mass with cystic and solid enhancing components. The patient underwent radical orchiectomy and postoperative pathology diagnosed mesothelioma of the tunica vaginalis of the testis. Mesothelioma of the tunica vaginalis of the testis is an exceptionally rare disease. We discuss the risk factors, imaging features, and treatment strategies of the disease.