PARATESTICULAR PSEUDOTUMOR IN AN ADOLESCENT PATIENT – A CASE REPORT

Abstract

Introduction: Paratesticular inflammatory and fibrous pseudotumors are rare benign lesions with unclear etiopathogenesis. They are considered to represent a reactive process associated with factors such as trauma and inflammatory conditions. Preoperative clinical and radiological differentiation of these benign paratesticular lesions from malignant tumors of this region remains extremely challenging. As a result, despite their benign nature, most of these lesions are treated by radical orchiectomy rather than testis-sparing surgery.

Case outline: We report the case of a 15-year-and-6-month-old adolescent hospitalized for diagnostic evaluation and treatment of a painful right scrotal mass measuring 5 × 4 cm. Laboratory findings revealed leukocytosis with neutrophilia, elevated inflammatory markers, and mildly increased neuron-specific enolase levels. Scrotal ultrasonography demonstrated a heterogeneous, highly vascularized paratesticular soft-tissue mass measuring 33 × 26 × 20 mm in the right hemiscrotum. Additional radiological evaluation failed to reliably exclude malignancy; therefore, a multidisciplinary decision was made to proceed with surgical treatment, and a right radical orchiectomy was performed. The definitive diagnosis was established by histopathological examination and corresponded to epididymitis subacuta partim abscedens.

Conclusion: Paratesticular pseudotumors represent a significant diagnostic challenge, particularly in the pediatric and adolescent population, primarily due to their rarity and clinical and radiological resemblance to malignant tumors of this region. The case highlights the importance of considering these benign entities in the differential diagnosis of paratesticular masses in order to avoid unnecessary radical surgical procedures whenever possible.