Chronic scrotal hematocele in an elderly patient: a case report in a tertiary hospital.

Introduction and importance: Chronic scrotal hematocele is an uncommon condition that typically results from the organization of a long-standing hematoma within the tunica vaginalis. We report a rare case of chronic scrotal hematocele. Case presentation: An 86-year-old man presented with a 4-year history of a progressively enlarging, painless right scrotal mass associated with a sensation of heaviness. Physical examination revealed a large, hard, non-tender, non-reducible mass with negative transillumination. Serum tumor markers were within normal limits. A right radical orchiectomy was performed via an inguinal approach. Intraoperative findings revealed a thickened, calcified tunica vaginalis containing dark, "chocolate-colored" fluid and a necrotic testicle. Discussion: This case illustrates the diagnostic dilemma posed by a chronic hematocele presenting in an elderly patient. The history of inguinal surgery likely led to occult trauma and slow, recurrent bleeding over many years. The use of an inguinal surgical approach adheres to oncologic principles, effectively managing both the benign final diagnosis and the pre-operative suspicion of cancer. Conclusion: Chronic hematocele should be considered in the differential diagnosis of any long-standing, hard scrotal mass, particularly in patients with a history of inguinoscrotal surgery. While imaging and tumor markers are valuable adjuncts, definitive diagnosis and treatment often require surgical exploration, even in the absence of imaging.