A 7-year-old male child presented with complaints of painless progressive swelling in the left scrotum noticed by parents for last 1 month. The patient had an unremarkable birth history and no significant past medical history. There was no history of trauma. On physical examination, the child was well nourished with normal developmental milestones. He had a normal uncircumcised phallus and a descended right testis. The left half of scrotum was enlarged, tensely cystic in consistency, and nontender. The scrotal skin of the left side was stretched. The swelling was not compressible but transilluminated brilliantly  [Figure 1]. The left testis was not palpable. There was no regional lymphadenopathy. The clinical diagnosis of hydrocele was made initially. On scrotal ultrasound, on the left side, unexpectedly there was no hydrocele; left testis was 13x23x21 mm (6.2 cc) in size and parenchyma was hypochoic as compared to right testis. Multiple tiny specks of parenchymal calcification were also noted. On color Doppler study, there was generalized hypervascularity as compared to the right side. Left epididymis was hypoechoic, hypovascular, and thickened. Right testis was homogenous in appearance and measured 22x11x10 mm (2.4 cc). The ultrasonologist reported it as suspected chronic epididymo-orchitis, and it may be tubercular. Additional investigations like complete blood count, liver function test, renal function test, chest X-ray, beta-HCG, serum alfa-fetoprotein (AFP), montoux test, ELISA for tuberculosis were conducted. All investigations were within normal limit.
During surgery, the testis was approached through a left inguinal skin crease incision. Vas and vessel were temporarily occluded after opening the inguinal canal. The testis was delivered, which looked normal in appearance but size was larger. On incising the testis, white gelatinous material with yellowish-white flakes came out and no solid component was found [Figure 2]. Orchidectomy was performed. The histopathological finding revealed benign mature cystic teratoma testis with component of all three germ layers, confined within the left testis [Figure 3]. At 3-month followup, the child is asymptomatic.