A Rare Cause of Massive Scrotal Elephantiasis: Case Report and Literature Review

ABSTRACT Scrotal lymphedema is a rare late complication of testicular cancer treatment, with most reported cases occurring in the early postoperative period. Massive scrotal elephantiasis manifesting more than a decade after postchemotherapy retroperitoneal lymph node dissection (pc‐RPLND) has not previously been described. We present a 44‐year‐old Aboriginal man with progressive scrotal swelling 12 years after treatment for Stage IIIc nonseminomatous germ cell tumor, including inguinal orchidectomy, four cycles of bleomycin, etoposide, and cisplatin chemotherapy, and pc‐RPLND for residual teratoma. The patient delayed presentation due to embarrassment and uncertainty about accessing care in his remote community. Examination revealed massive scrotal elephantiasis. Imaging and tumor markers excluded recurrence or infection. He underwent scrotectomy with primary reconstruction, yielding 2076 g of tissue showing lymphangiectasia, dermal fibrosis, and chronic inflammation without malignancy. Postoperative recovery was uneventful, with marked improvements in mobility and quality of life. This case illustrates an exceptionally rare, delayed manifestation of massive scrotal lymphedema following pc‐RPLND, likely due to combined surgical disruption of lymphatic drainage and bleomycin‐induced endothelial injury. It underscores the need for long‐term surveillance, patient education regarding late complications, and culturally safe, coordinated cancer care, particularly for Indigenous patients in rural and remote settings.