A Complex Testicular Lesion With Evolving Sonographic Features: A Case Report

ABSTRACT This case presents a diagnostically challenging presentation of a 21‐year‐old male with longstanding, asymptomatic right testicular swelling who presented with acute pain and fever. Initial ultrasound documented complex cystic changes but was reported as likely spermatocele with mild infection and follow‐up was arranged. Interval imaging demonstrated a large, mixed solid‐cystic intratesticular mass with internal vascularity, raising concern for malignancy. The patient underwent radical orchidectomy with histopathology confirming a pure teratoma, prepubertal type, with no evidence of germ cell neoplasia in situ (GCNIS). This case highlights the importance of carefully correlating lesion location (intratesticular vs. extratesticular), recognising evolving sonographic features, and arranging timely follow‐up when findings and clinical evolution diverge from a benign diagnosis.