Giant testicular seminoma with atypical painful presentation and delayed diagnosis: a case report

Giant testicular tumours are rare in contemporary practice and are typically associated with delayed diagnosis and advanced disease. We report a 32-year-old male presenting with a 1-month history of progressively enlarging, painful right-sided scrotal swelling, initially mischaracterized on ultrasound imaging performed abroad. Examination revealed marked scrotal enlargement with overlying erythema and a buried penis. Computed tomography demonstrated a large right testicular mass with retroperitoneal lymphadenopathy, without distant metastases. Serum tumour markers showed elevated β-human chorionic gonadotropin and lactate dehydrogenase, with normal alpha-fetoprotein. The patient underwent urgent radical inguinal orchidectomy. Histopathology confirmed a pure seminoma measuring 15.8 cm with lymphovascular invasion and spermatic cord involvement (pT3). Post-operatively, tumour markers declined significantly, and the patient was commenced on bleomycin, etoposide, and cisplatin chemotherapy. This case emphasizes that painful scrotal swelling does not exclude malignancy and highlights the importance of early recognition and multidisciplinary management.