Isolated Testicular Tuberculosis Mimicking a Testicular Tumor: A Case Report and Review of the Literature.

BACKGROUND: Testicular tuberculosis is a rare form of extrapulmonary tuberculosis (EPTB). Due to the nonspecific nature of its clinical manifestations and imaging features, it is often misdiagnosed as a malignant testicular tumor, leading to unnecessary radical orchiectomy. Accurate preoperative diagnosis is essential for organ preservation and appropriate antituberculous therapy. CASE: A 59‑year‑old male patient was admitted with a 4‑day history of left testicular enlargement. Pre‑admission ultrasonography suggested "a solid mass in the left testicle, suspected seminoma." Physical examination revealed enlargement of the left testicle with moderate consistency. Scrotal ultrasound, contrast‑enhanced ultrasound, and enhanced CT all supported the diagnosis of testicular malignancy. The patient underwent left radical orchiectomy. However, postoperative pathology revealed extensive acute and chronic inflammatory cell infiltration, caseous necrosis, and granulomatous inflammation within the testicular tissue, consistent with tuberculous pathology. The final pathological diagnosis was "left testicular tuberculosis." CONCLUSION: Testicular tuberculosis is an important differential diagnosis for testicular tumors. Despite advances in modern imaging techniques, atypical presentation remains highly prone to misdiagnosis. Clinicians should maintain a high index of suspicion for testicular tuberculosis in patients with atypical clinical and imaging findings of testicular masses. When feasible, obtaining tissue samples for histopathological and molecular examination preoperatively or intraoperatively may be crucial in avoiding unnecessary orchiectomy and achieving organ preservation.