A Huge Testicular Fibrous Inflammatory Pseudotumor - A Rare Case Report and Literature Review

Abstract: Testicular fibrous inflammatory pseudotumors represent a rare pathological entity characterized by diagnostic challenges and histopathological complexity. These lesions, composed of myelofibroblastic spindle cells amidst a backdrop of chronic inflammation, pose difficulties in pre-operative evaluation due to their resemblance to malignant testicular neoplasms. A middle-aged man, Mr. A, with a history of right inguinal hernioplasty, presented with a two-month history of progressively enlarging right scrotal swelling. Physical examination revealed a sizable, semi-solid testicular mass measuring 20x20 cm, with serum tumor markers within normal limits. Scrotal ultrasound depicted extensive cystic lesions with sedimentation, obscuring the normal testicular architecture. Subsequent thoracoabdominal pelvis (TAP) CT imaging delineated a right scrotal cystic lesion measuring 11x9 cm superiorly and 11x11 cm inferiorly, indicative of an encysted hydrocele with concurrent hydrocele of the right testis. Surgical intervention via high inguinal ligation orchidectomy revealed a complex histopathological composition comprising myelofibroblastic cells, fibrin, necrotic materials, and hematoma within the excised specimen.The anatomic location of paratesticular tumors, normal testicular tumor markers, elevated IgG4 levels, and ultrasound findings help distinguish benign pseudotumors from malignancies. Intraoperative frozen section biopsy is crucial before definitive testicular sparing surgery. Testicular sparing surgery emerges as the standard of care in managing testicular pseudotumors. Keywords: Fibrous inflammatory pseudotumor, Testicular neoplasm, High inguinal orchidectomy, Testicular sparing surgery