An autopsy case of malignant mesothelioma of the tunica vaginalis testis in a 60‐year‐old man is described. The tumor showed widespread metastasis via the lymphatics, leading to the patient's death five years after diagnosis. A review of 38 previously described cases is also presented. The most frequent presenting symptom was hydrocele. When a hydrocele in association with a paratesticular tumor is present, aspiration cytology should be performed first. In most of the cases with a fatal outcome, the tumors metastasized to the retroperitoneal lymph nodes. Once the diagnosis has been made, lymphangiography or CT scan should be done immediat
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