Primary Testicular Tuberculosis Presenting as a Testicular Tumor: A Case Report.

Testicular tuberculosis (TB) is a rare form of extrapulmonary TB that can closely mimic testicular malignancy, making diagnosis challenging in immunocompetent patients without systemic symptoms. We report the case of a 50-year-old immunocompetent man who presented with a gradually enlarging, painless right testicular mass of several weeks' duration, without constitutional symptoms such as fever, night sweats, or weight loss. Ultrasonography revealed a well-defined, heterogeneous hypoechoic and relatively hypervascular solid-cystic lesion, while serum tumor markers were within normal limits. Given the high clinical suspicion for malignancy, radical inguinal orchiectomy was performed without complications. Histopathological examination demonstrated necrotizing granulomatous inflammation with Langhans-type giant cells, and Ziehl-Neelsen staining was positive for acid-fast bacilli. Comprehensive systemic evaluation revealed no evidence of pulmonary or extrapulmonary TB, although both PPD and IGRA tests were positive. The patient was treated with standard anti-tubercular therapy and remained asymptomatic at 9-month follow-up. This case underscores the importance of considering primary isolated testicular TB in the differential diagnosis of atypical testicular masses, highlighting that early recognition and appropriate medical therapy may prevent unnecessary.