Testicular swellings simulating malignancy. Clinical pitfalls, sonographic and histopathological correlation

ABSTRACT

The final diagnosis of twenty-eight consecutive male patients presented with unilateral testicular swelling, underwent inguinal orchiectomy due to suspected testicular malignancy was correlated with the results of the clinical and sonographic examinations. A high index of suspicion arose primarily from the patients history, clinical examination of the swelling and its appearance on scrotal ultrasonography. Histopathological examination proved the existence of testicular malignancy in 2 cases [7.1%]. The final diagnosis of the remaining 26 cases, based on histopathological examination, was tuberculosis in one case [3.6%], testicular infarction in 2 cases [7.1%], neglected torsion in 6 cases [21.4%], filariasis in one case [3.6%], chronic nonspecific orchitis in 9 cases [32.1%] and granulomatous orchitis in 7 cases [25%]. All were found to simulate malignant tumors either in their clinical presentation, local examination or ultrasonographic appearance. Benign testicular swellings simulating malignancy are not rare and hence differential diagnosis of testicular tumors should be expanded to include chronic and granulomatous orchitis, testicular infarction, neglected torsion as well as tuberculosis and filariasis. The decision of orchiectomy should be properly judged in view of the under-estimated incidence of benign swellings simulating malignancy