A 90 year old patient went to his local urologist for progressive enlargement of the left hemiscrotal bone, of approximately 2-3 years' evolution, and possible interference with the micturition pattern.
The only personal history of the patient was hypertension.
Physical examination revealed a very large left hemiscrotal, under tension, with positive transillumination and in which the testicle could not be palpated. The right testicle, which is lateralised due to the size of the left hemiscrotal, and the epididymis were not altered on examination. The patient was in good general condition.
In view of these exploratory findings, a Doppler ultrasound was requested, which was reported as a large left hydrocele, heterogeneous left testicle with areas of increased Doppler flow and multiple calcifications, suggesting chronic orchiepididymitis. Right testicle without alterations.
It was decided to perform a left orchiectomy via the inguinal route and also to perform surgical treatment of the hydrocele, from which 700 ml were evacuated. The macroscopic appearance of the specimen was reported as a testicle entirely occupied by a tumour measuring 8.7 x 6 cm which does not infiltrate the capsule. The tumour shows solid orange-coloured areas together with haemorrhagic microcystic areas. Macroscopically, the tumour did not appear to reach the epididymal head or the tunica vaginalis. Histologically it was a Leydig cell tumour with malignant criteria (positive for vicentin, focally for CK22 and AEI-AE3 and S-100, negative for PLAP, CD30, CD117, CD45, CD20 and chromogramin). Nuclear pleomorphism, mitotic activity, foci of necrosis, without vascular embolisation. The tumour focally infiltrates the capsule without extending beyond it. Rete testis, epididymis and albuginea are not infiltrated.
The extension study with chest X-ray and abdomino-pelvic CT scan was negative. Tumour markers showed normal values.
Ten months after the operation, the patient was in good general condition with negative markers and no radiological signs of distant metastasis. The possibility of complementary treatments was ruled out due to the age of the patient and the excellent evolution.