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A patient in his early 60s with a long-standing history of scrotal swelling and recent onset of pain underwent high inguinal orchidectomy due to a suspected testicular malignancy. Tumour markers were normal, but histopathological examination revealed caseating granulomas, confirming tuberculous epididymo-orchitis. He was diagnosed with genitourinary tuberculosis and initiated on anti-tubercular therapy. The patient responded well to treatment with no recurrence. This case highlights the importance of considering tuberculosis in the differential diagnosis of testicular lesions and the critical role of histopathology in confirming the diagnosis.