Testicular Seminoma Presenting as a Presumed Hydrocele: A Case Report

Abstract

Testicular seminoma may occasionally present as an apparent hydrocele, potentially delaying recognition of an underlying malignancy and leading to inappropriate surgical planning. This case report describes a 56-year-old man who sought a second opinion for a progressively enlarging left scrotal swelling that had previously been diagnosed as a hydrocele. Clinical reassessment demonstrated a firm, non-tender, non-transilluminant mass, and the left testis could not be palpated separately. Scrotal Doppler ultrasonography revealed a heterogeneous, hypervascular intratesticular mass measuring 8.2 × 7.6 × 10 cm. Serum alpha-fetoprotein was within the normal range, whereas β-human chorionic gonadotropin and lactate dehydrogenase were elevated. Staging assessment showed no radiologically confirmed retroperitoneal nodal or distant metastatic disease, although indeterminate hepatic lesions were noted on computed tomography. The patient underwent left radical high inguinal orchidectomy without scrotal violation. Histopathological examination confirmed classical testicular seminoma with epididymal, rete testis, and tunical involvement and lymphovascular invasion, staged as pT2N0M0S0, Stage I. Post-orchidectomy tumour markers normalised, and active surveillance was selected following multidisciplinary discussion and shared decision-making. The case demonstrates the importance of careful clinical reassessment of presumed hydrocele, particularly when the swelling is firm, does not transilluminate, or prevents separate palpation of the testis, so that occult testicular malignancy can be identified before scrotal surgery.