AIM: This case experience aims to question the current know-how when a masked testicle malignancy occurs, in order to achieve the correct clinical framework and avoid mistakes during surgical procedures. in the evaluation MATERIALS AND METHODS: A 36-year-old male patient was admitted with an incorrect diagnosis of left-sided incarcerated inguinoscrotal hernia, and then discovered a seminomatous testicular neoplasm matched with a hypertensive ipsilateral hydrocele. Therefore, we performed a radical epididymo-orchiectomy and referred the patient to the oncologist for adjuvant chemotherapy after discharge. RESULTS: The surgery was perceived by the patient as the best possible treatment because the symptoms were relieved. DISCUSSION: A 36-year-old male patient was admitted to our surgical department due to an incorrect diagnosis of left- sided incarcerated inguinoscrotal hernia, consequently to a misguided scrotal ultrasound-doppler exam. During the urgent surgical operation, we realized that we were dealing with an enormous 17x10x9 cm seminomatous testicular neoplasm matched with a hypertensive ipsilateral hydrocele. Therefore, we performed a radical epididymo-orchiectomy and referred the patient to the oncologist for adjuvant chemotherapy after discharge. CONCLUSION: This case report points out that there may be a poor correlation between clinical ndings and patho- physiologic processes a ecting scrotal structures. Additional radiological investigations, such as CT scan, could clarify and confirm the clinical scenario, improving the preoperative planning and surgical outcomes.