Rare Non-germ Cell Testicular Tumors: A Series of Three Cases

Testicular neoplasms are the most common malignancy among men aged 20-40 years. More than 95% are germ cell tumours and 5% are sex cord stromal tumours. The most common presentation is a painless scrotal lump. Sometimes, it may present as a painful lump, mimicking an inflammatory lesion. Case 1, a 34-year-old male presented with right testicular pain and a lump for one month, with normal tumour markers. Clinically, it appeared as a testicular malignancy, but with normal tumour markers, it mimicked an inflammatory lesion, creating a management dilemma. A Computed Tomography (CT) scan ruled out retroperitoneal lymph node metastasis. Right high inguinal orchidectomy with frozen section was performed, suggesting malignancy. Immunohistochemistry confirmed leiomyosarcoma. Case 2, an 82-year-old male presented with a painless right testicular lump for one month, with a history of acute urinary retention secondary to benign prostatic enlargement {treated with Transurethral Resection of the Prostate (TURP)}. Clinically, it was a hard lump suggestive of malignancy, confirmed on ultrasound, although tumour markers were normal. A CT scan was negative for lymphadenopathy. Right high inguinal orchidectomy was performed. Histopathological examination showed non-Hodgkin’s lymphoma; the patient subsequently underwent chemotherapy. Case 3, a 29-year-old male complained of right testicular pain. Examination revealed a tender nodule (1×1 cm) on the posterolateral aspect of the right testis, clinically appearing as a firm mass, confirmed on ultrasonography, although tumour markers were misleadingly normal. High inguinal orchidectomy was performed, with histopathological examination positive for intratesticular adenomatoid tumour. High inguinal orchidectomy was the treatment of choice in all three cases, followed by adjuvant chemotherapy or radiotherapy depending on histopathology. Conclusion: Testicular tumours may mimic inflammatory lesions, creating management dilemmas. Thorough clinical examination and investigations are required for planning and management. Normal serum tumour markers and ultrasound cannot rule out malignancy.