Malignant mesothelioma is a rare and aggressive tumour, generally asbestos-related. When the tumour arises in the pleura or peritoneum a non-occupational or environmental asbestos exposure has also been reported. The latency period from the initial asbestos exposure to the clinical diagnosis is variable but usually long, sometimes as long as 30-40 years. Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is extremely rare; in Italy, the standardized incidence rate for MMTVT is 0.2 cases per million inhabitants. Usually, in this site the tumour appears to be idiopathic in nature but exceptionally, an asbestos exposure has been documented. Here, we report two patients with locally advanced disease; an occupational history of asbestos exposure was ascertained in one case. Radical surgery was performed and adjuvant chemotherapy was administered only in one case.