POSTPUBERTAL TESTICULAR TERATOMA IN AN ADOLESCENT MALE PRESENTING AS A LONG-STANDING STABLE SCROTAL MASS: A CASE REPORT AND LITERATURE REVIEW

Background: Testicular teratomas are uncommon germ cell tumours with distinct biological behaviour depending on patient age. In prepubertal males, teratomas are generally benign, whereas in postpubertal males they are regarded as malignant or potentially malignant regardless of histologic maturity. Their presentation as a long-standing stable testicular mass since childhood may create diagnostic uncertainty.
Case Presentation: A 16-year-old male presented with a hard, non-tender left testicular mass that had been present since childhood without significant increase in size. There were no constitutional symptoms or local inflammatory changes. Scrotal ultrasonography demonstrated a well-defined cystic lesion with internal septations and no internal vascularity. Contrast-enhanced CT of the thorax, abdomen, and pelvis showed a heterogeneous left scrotal lesion containing fat, soft tissue, and cystic components, favouring a mature cystic teratoma, along with sub-centimetre para-aortic lymph nodes and an indeterminate 4 mm pulmonary nodule. Serum tumour markers (AFP, β-hCG, LDH) were normal. The patient underwent left radical inguinal orchidectomy. Histopathology confirmed a 35 mm pure teratoma composed of cartilage, skin with adnexal structures, and respiratory epithelium, completely excised, confined to the testis, with no intratubular germ cell neoplasia and negative spermatic cord margin.
Conclusion: This case highlights the importance of managing any intratesticular mass in an adolescent/postpubertal male as malignant until proven otherwise, even when the lesion is long-standing and radiologically suggestive of mature teratoma. Radical inguinal orchidectomy remains the standard diagnostic and therapeutic approach. Histopathological distinction between prepubertal-type and postpubertal teratoma has important prognostic implications, and close surveillance is warranted.