An 86 year-old male consulted our department for examination of a huge left-sided scrotal mass which was focally painful. The patient had a history of trauma at the perineum 30 years previously.Examination revealed marked swelling of the left side of the scrotum. The involved scrotal skin was focally inflamed (ulcerated). On investigation, we could not distinguish the left testis or epididymis from the mass by palpation. After admission, the serum levels of tumor markers (alpha-fetoprotein, carcinoembryonic antigen, β- human chorionic gonadotropin) were within normal limits.U/S and MRI did not exclude a testicular tumor completely. As it was impossible to exclude a malignant tumor, especially testicular carcinoma, the tumor was resected by a left high orchiectomy. The histopathological diagnosis was an organized hematocele, and the left testis was located separately from the mass, having normal appearance. This entity should be considered in the differential diagnosis of scrotal masses, even in the absence of a clear history of trauma. Introduction Hematocele is an accumulation of blood within the tunica vaginalis sac. Chronic hematoceles are rare scrotal masses. Possible causes most often include direct trauma of the scrotum, torsion, tumor and surgery. Large hematoceles distort the adjacent testis, leading to increased suspicion of malignancy, both clinically and sonographically1-4. Since correct preoperative diagnosis is problematic unnecessary orchiectomy is not uncommon.We report a case of chronic hematocele resembling testicular tumor, in an elderly patient. Case Report An 86-year-old man presented with a left-sided scrotal mass which extended in the internal femoral region. The patient refers that he had been kicked in the scrotal area by a horse while plowing his farm 30 years ago. This injury caused severe pain and swelling of the scrotal area, which the patient treated by remaining at bed rest for several days. He related that the swelling of the left side of the scrotum had been persistent ever since.The mass was asymptomatic, except for a local discomfort caused by its size. Last month prior to admission, the involved scrotal skin was locally inflamed (ulcerated) with some degree of pain.Physical examination revealed that the left side of scrotum was occupied by a large, hard, nontender mass, gradually increasing in size, measuring more than 20 cm. in diameter (fig.1). The mass did not transmit light. The left testis and epididymis could not be detected. Blood markers for testicular tumors such as human chorionic gonadotropin (HCG), alpha-fetoprotein (AFP) and carcino-embryonic antigen (CEA) were found to be within normal levels. The right lower extremity had a motor neuron paralysis as a neurologic residual of poliomyelitis.Ultrasonography of the scrotum yielded suspicion of a testicular neoplasm, but could not conclude the diagnosis. Magnetic resonance imaging (MRI) revealed a well-defined encapsulated left solid mass with areas of septations and loculations(fig.2).Left high inguinal orchiectomy was performed,since it was difficult to exclude completely a testicular tumor. Αt surgery, a well-encapsulated mass which consisted of a normal testicle surrounded by a thick-walled sac was discovered.Grossly, the resected mass measured 22X16X8 cm in diameter and 1200 gr in weight.It consisted of a cavity having a thick capsule,filled with old brownish clotted blood (fig.3).
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