A 90-year-old patient came to his urologist in the area due to a progressive increase of the left hemiscrotum, of approximately 2-3 years of evolution, and possible interference on the voiding pattern.
The only personal history to mention was hypertension.
The physical examination revealed a large left hemiscrotum, with a very large tension, with positive transition, and in which the testicle could not be removed.
The right testicle, which is lateralized by the size of the left hemiscrotum, and its epididymis did not present alterations in its exploration.
The patient is in good general condition.
Because of these exploratory findings, Doppler ultrasonography was requested, which was reported as a large left hydrocele, heterogeneous left testicle with areas with increased doppler flow and multiple epi-calcifications, which suggested chronic orchidism.
Right testicle was normal.
It was decided to perform left orchiectomy via inguinal approach and also perform surgical cure of hydrocele, of which 700 ml were evacuated.
The macroscopic aspect of the specimen was reported as a testicle completely occupied by a tumor of 8.7 x 6 cm that did not exhibit capsule formation.
The torsion has solid areas with hemorrhagic color and microcystic areas.
The tumor does not appear macroscopically to reach the head of the epididymis or the tunica vaginalis.
Histologically, it was a Leydig cell tumor with malignancy criteria (positivity for vicentine, focally for CK22 and AEI-AE3 and S-100, CDgram, CD30).
Nuclear pleomorphism, mitotic activity, necrosis foci, without vascular embolization being observed.
The tumour is localized over the capsule.
Rete testis, epididymis and albuginea were not infiltrated.
The extension study with chest X-ray and CT scan to non-pelvic know-how was negative.
Tumor markers showed normal values.
Ten months after surgery, the patient presents a good general condition with negative markers and no signs of distant metastasis.
Treatment options are based on patient age and excellent outcome.
