When Infection Hides Malignancy: A Rare Case of Testicular Seminoma Presenting as Scrotal Abscess
O. Z. Bakkali Aissaoui *
Department of Urology, Mohammed VI University Hospital of Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaâdi University, 90000 Tangier, Morocco.
A. Gaudan
Department of Urology, Mohammed VI University Hospital of Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaâdi University, 90000 Tangier, Morocco.
Y. Retal
Department of Urology, Mohammed VI University Hospital of Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaâdi University, 90000 Tangier, Morocco.
A. Khallouk
Department of Urology, Mohammed VI University Hospital of Tangier, Faculty of Medicine and Pharmacy, Abdelmalek Essaâdi University, 90000 Tangier, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Testicular cancer is the most common solid tumour in young men and predominantly comprises germ cell tumours, most commonly seminomas. Although it typically presents as a painless testicular mass, atypical presentations that mimic inflammatory or infectious processes may occur and delay diagnosis.
Case Présentation: We report the case of a 55-year-old man who presented with a one-month history of painful left scrotal swelling, fever, and asthenia and had initially been treated for epididymo-orchitis.
Investigations: Scrotal ultrasonography revealed heterogeneous testicular parenchyma with intraparenchymal and subcutaneous abscess collections. Despite broad-spectrum antibiotic therapy and surgical drainage, the intraoperative findings raised a strong suspicion of malignancy.
Surgical Management: The patient underwent inguinal orchidectomy.
Histopathological Examination: A testicular seminoma infiltrating the scrotal wall was confirmed.
Follow-up: One cycle of carboplatin was administered as adjuvant therapy. At the two-year follow-up, there was no evidence of recurrence or metastasis.
Discussion: Testicular cancer, which predominantly comprises germ cell tumours, can mimic benign scrotal conditions such as abscess or epididymo-orchitis and delay diagnosis. Serum tumour marker assessment is mandatory, but normal results do not exclude malignancy. Scrotal ultrasonography is the first-line imaging modality, with sensitivity exceeding 90%; MRI may provide greater diagnostic accuracy when ultrasonographic findings are inconclusive. Radical inguinal orchidectomy remains the standard surgical treatment; atypical or antibiotic-resistant scrotal presentations warrant consideration of inguinal exploration to exclude malignancy.
Conclusion: This case highlights the diagnostic challenge posed by a testicular tumour presenting as a scrotal abscess. Persistent or atypical scrotal infections that do not respond to antibiotic therapy should raise suspicion of an underlying malignancy. Early imaging and appropriate surgery support accurate diagnosis and favourable outcomes.
Keywords: Testicular seminoma, scrotal abscess, epididymo-orchitis, testicular malignancy, scrotal ultrasonography, magnetic resonance imaging, radical inguinal orchidectomy, normal tumour markers, atypical presentation