DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.046

Pages: 2622-2625

Introduction: Urogenital tuberculosis is the second most common form of extrapulmonary tuberculosis, and the epididymis is the most frequently involved site within the male genital tract. Its clinical and radiological presentation is often non-specific and may closely mimic a testicular malignancy, making preoperative diagnosis particularly challenging. Case presentation: We report the case of a 50-year-old man who presented with a painful right scrotal mass and fever, three months after epididymectomy and antituberculous therapy for epididymal tuberculosis. Physical examination revealed a 6cm ulcero-proliferative scrotal tumor with skin involvement, and scrotal ultrasound showed an isoechoic, hypovascular lesion. Given the strong clinical suspicion of malignancy, a right radical orchiectomy was performed. Histopathological examination demonstrated necrotizing granulomatous inflammation with caseous necrosis, confirming tuberculosis, with clear resection margins and no evidence of malignancy. Antituberculous therapy was subsequently reinitiated. Conclusion: Epididymal tuberculosis can closely mimic testicular malignancy both clinically and radiologically. It should be considered in the differential diagnosis of any scrotal mass, particularly in tuberculosis-endemic regions, and histopathological confirmation remains essential to establish the diagnosis, guide management, and avoid unnecessary radical surgery whenever possible.