45-Year-old with testicular mixed germ-cell tumor associated with massive hydrocele and a misleading CT scan showing bilateral testicles involvement: A case report.

Testicular mixed germ cell tumors (TMGCTs) are rare malignancies, occasionally presenting with hydrocele, and potentially complicating the diagnosis. We report a 45-year-old male with a massive hydrocele and elevated AFP. CT suggested bilateral testicular tumors, but intraoperatively the left testis appeared normal and was preserved. Histopathology confirmed seminoma; however, due to high AFP, treatment followed TMGCT protocols. subsequent MRI of the left testis was negative. This case highlights the limitations of imaging and pathology alone and stresses the importance of integrating tumor markers, intraoperative findings, and clinical judgment for accurate diagnosis and optimal management of testicular tumors.