Hydrocele or cancer?

HydroceleI would like to share with you this interesting case report: A 24 year old male patient came to me with a rt sided testicular swelling. He was very pale and according to his brother, has recently lost weight.

Examination revealed, a large (4″X4″), hard non tender lump. It was obviously solid. I could not feel the testes separately. Lt sided testes was normal with a small vaginal hydrocele. There was no palpable LNs in any region. Patient mentioned that he is having this swelling for last 24 years. Hb was 50%. LFT were normal. Chest X-ray was normal. USG didnot reveal the presence of any enlarged abdominal LNs.USG of the affected testes reported a solid swelling with variable tissue consistency. AFT level was 2.2 (normal <1).

I was confused, history said it was hydrocele, everything else pointed towards a testicular tumour. I discussed this with the patient who agreed for exploration with possible orchidectomy. I explored via the inguinal approach, soft clamped the spermatic cord and brought out the testes. It now looked more like a cancer (teratoma). I cut through the testes after packiing the surrounding tissue. Surprise! It was a thick walled (approx 1.5″) cyst containg a fluid like thick soup, the testes was reduced to small olive embedded in the post wall. I then procceded with the orchidectomy. Pt had an uneventful recovery. Any comments ?

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  2. Herky
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