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==[[Scrotal mass causes|Causes]]==
==[[Scrotal mass causes|Causes]]==
*Scrotal mass may be caused by [[tumor]], [[infection]], [[injury]], [[inflammation]], or fluid buildup, which can cause different types of masses.<ref name="causeofscrotalmasses">Causes of scrotal masses. The Urology Group 2016. http://urologygroup.com/conditions-we-treat/scrotal-masses/. Accessed on March 17, 2016</ref>
{|style="width:85%; height:90px" border="1"
!style="padding: 0 5px; background: #DCDCDC" colspan=5 | {{fontcolor|#000|'''Common Causes of Scrotal Mass'''<br><sub>Adapted from American Academy of Family Physicians.<ref name=causescrotalmass1>Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016</ref></sub>}}
|-
! Cause
! Clinical Presentation
! Diagnosis
! Treatment
|-
| style="padding: 0 5px; background: #F5F5F5" align=center| [[Testicular torsion]]
| style="padding: 0 5px; background: #F5F5F5" | Acute unilateral pain and swelling<br>High position of the testicle<br>Abnormal cremasteric reflex<br>Nausea/vomiting
| style="padding: 0 5px; background: #F5F5F5" | Mostly clinical, with or without sonography
| style="padding: 0 5px; background: #F5F5F5" | Surgery
|-
| style="padding: 0 5px; background: #F5F5F5" align=center | [[Appendix testis|Torsion of the testicular appendage]]
| style="padding: 0 5px; background: #F5F5F5" | Acute unilateral pain<br>No swelling<br>Blue dot sign(bluish discoloration of the scrotum over the superior pole)
| style="padding: 0 5px; background: #F5F5F5" | Sonography
| style="padding: 0 5px; background: #F5F5F5" | Pain control
|-
| style="padding: 0 5px; background: #F5F5F5" align=center | [[epididymo-orchitis|Epididymis/orchitis]]
| style="padding: 0 5px; background: #F5F5F5" | Acute unilateral pain and swelling<br>Normal position of the testicle<br>Erythema of the scrotal skin<br>Fever<br>Dysuria
| style="padding: 0 5px; background: #F5F5F5" | Mostly clinical, with or without sonography
| style="padding: 0 5px; background: #F5F5F5" | Ceftriaxone and doxyxycline
|-
| style="padding: 0 5px; background: #F5F5F5" align=center | [[Hematocele]]
| style="padding: 0 5px; background: #F5F5F5" | History of trauma<br>Pain and swelling
| style="padding: 0 5px; background: #F5F5F5" | Sonography or surgerical exploraion
| style="padding: 0 5px; background: #F5F5F5" | Main focus on pain control. Surgery, if needed
|-
| style="padding: 0 5px; background: #F5F5F5" align=center | [[Inguinal hernia]]
| Unilateral bulge in the scrotum<br>Pain with Valsalva maneuvers
| style="padding: 0 5px; background: #F5F5F5" | Physical examination, sonography
| style="padding: 0 5px; background: #F5F5F5" | Surgery
|-
| style="padding: 0 5px; background: #F5F5F5" align=center | [[Hydrocele]]
| style="padding: 0 5px; background: #F5F5F5" | Swelling
| style="padding: 0 5px; background: #F5F5F5" | Transillumination, sonography
| style="padding: 0 5px; background: #F5F5F5" | Main focus on pain control. Surgery, if needed
|-
| style="padding: 0 5px; background: #F5F5F5" align=center | [[Varicocele]]
| style="padding: 0 5px; background: #F5F5F5" | Dull testicular ache while in standing position<br>
Scrotal mass
| style="padding: 0 5px; background: #F5F5F5" | "Bag of worms" on palpation
| style="padding: 0 5px; background: #F5F5F5" | Scrotal support, surgery if needed
|-
| style="padding: 0 5px; background: #F5F5F5" align=center | [[Testicular cancer]]
| style="padding: 0 5px; background: #F5F5F5" | Unilateral, firm nodule
| style="padding: 0 5px; background: #F5F5F5" | Sonography, positive tumor markers
| style="padding: 0 5px; background: #F5F5F5" | Surgery
|-
| style="padding: 0 5px; background: #F5F5F5" align=center | [[Skin cancer]]
| style="padding: 0 5px; background: #F5F5F5" | History of carcinogens<br>Erosive, vascular, hyperkeratotic, or nonhealing; irregular border; color changes
| style="padding: 0 5px; background: #F5F5F5" | Biopsy
| style="padding: 0 5px; background: #F5F5F5" | Surgery
|}
===Causes by Anatomic Origin===
{|style="width:85%; height:90px" border="1"
!style="padding: 0 5px; background: #DCDCDC" colspan=5 | {{fontcolor|#000|'''Scrotal Mass'''<br><sub>Adapted from American Academy of Family Physicians.<ref name=causescrotalmass1>Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016</ref></sub>}}
|-
! style="padding: 0 5px; background: #4479BA" | {{fontcolor|#FFF|Anatomical Origin}}
! style="padding: 0 5px; background: #4479BA" | {{fontcolor|#FFF|Lesion/Condition}}
! style="padding: 0 5px; background: #4479BA" | {{fontcolor|#FFF|Onset/Progression}}
! style="padding: 0 5px; background: #4479BA" | {{fontcolor|#FFF|Pain/Tenderness}}
! style="padding: 0 5px; background: #4479BA" | {{fontcolor|#FFF|Aggravating/Alleviating Factors, Associated Symptoms}}
|-
| rowspan="2" style="padding: 0 5px; background: #F5F5F5" |[[Skin]]
| style="padding: 0 5px; background: #F5F5F5" | '''[[Sebaceous cyst]]'''
| style="padding: 0 5px; background: #F5F5F5" | Acute/chronic, stable
| style="padding: 0 5px; background: #F5F5F5" | No
| style="padding: 0 5px; background: #F5F5F5" | ---
|-
| style="padding: 0 5px; background: #F5F5F5" | '''[[Squamous cell carcinoma]]'''
| style="padding: 0 5px; background: #F5F5F5" | Chronic, progressive
| style="padding: 0 5px; background: #F5F5F5" | No
| style="padding: 0 5px; background: #F5F5F5" | ---
|-
| rowspan="2" style="padding: 0 5px; background: #F5F5F5" | [[Tunica vaginalis testis]]
| style="padding: 0 5px; background: #F5F5F5" | '''[[Hydrocele]]'''
| style="padding: 0 5px; background: #F5F5F5" | Acute/chronic, stable
| style="padding: 0 5px; background: #F5F5F5" | No
| style="padding: 0 5px; background: #F5F5F5" | Positive '''transillumination'''
|-
| style="padding: 0 5px; background: #F5F5F5" | '''[[Hematocele]]'''
| style="padding: 0 5px; background: #F5F5F5" | Acute, caused by trauma
| style="padding: 0 5px; background: #F5F5F5" | Yes
| style="padding: 0 5px; background: #F5F5F5" | Negative transillumination
|-
| rowspan="2" style="padding: 0 5px; background: #F5F5F5" | [[appendix testis|Processus vaginalis testis]]
| style="padding: 0 5px; background: #F5F5F5" | '''[[Indirect inguinal hernia]]'''
| style="padding: 0 5px; background: #F5F5F5" | Acute/chronic, stable or progressive
| style="padding: 0 5px; background: #F5F5F5" | No; yes, if strangulated
| style="padding: 0 5px; background: #F5F5F5" | May enlarge with Valsalva-type maneuvers; size may fluctuate
|-
| style="padding: 0 5px; background: #F5F5F5" | '''[[Hydrocele]]'''
| style="padding: 0 5px; background: #F5F5F5" | Chronic, stable
| style="padding: 0 5px; background: #F5F5F5" | No
| style="padding: 0 5px; background: #F5F5F5" | ---
|-
| style="padding: 0 5px; background: #F5F5F5" | [[Pampiniform plexus]]
| style="padding: 0 5px; background: #F5F5F5" | '''[[Varicocele]]'''
| style="padding: 0 5px; background: #F5F5F5" | Chronic, stable
| style="padding: 0 5px; background: #F5F5F5" | No
| style="padding: 0 5px; background: #F5F5F5" | Characteristic "'''bag of worms'''" consistency
|-
| rowspan="2" style="padding: 0 5px; background: #F5F5F5" | [[Epididymis]]
| style="padding: 0 5px; background: #F5F5F5" | '''[[Epididymitis]]'''
| style="padding: 0 5px; background: #F5F5F5" | Acute, progressive
| style="padding: 0 5px; background: #F5F5F5" | Yes
| style="padding: 0 5px; background: #F5F5F5" | May have symptoms of urinary tract infection (fever, chills, dysuria, frequency, and urgency)
|-
| style="padding: 0 5px; background: #F5F5F5" | '''[[Spermatocele]]'''
| style="padding: 0 5px; background: #F5F5F5" | Chronic, stable
| style="padding: 0 5px; background: #F5F5F5" | No
| style="padding: 0 5px; background: #F5F5F5" | ---
|-
| rowspan="4" style="padding: 0 5px; background: #F5F5F5" | [[Testis]]
| style="padding: 0 5px; background: #F5F5F5" | '''[[Testicular torsion]]'''
| style="padding: 0 5px; background: #F5F5F5" | Acute, progressive
| style="padding: 0 5px; background: #F5F5F5" | Yes
| style="padding: 0 5px; background: #F5F5F5" | Elevation of testis may '''aggravate''' pain; abnormal testicular lie; cremasteric reflex usually '''absent'''
|-
| style="padding: 0 5px; background: #F5F5F5" | '''[[appendix testis|Appendix testis torsion]]'''
| style="padding: 0 5px; background: #F5F5F5" | Acute, stable
| style="padding: 0 5px; background: #F5F5F5" | Yes
| style="padding: 0 5px; background: #F5F5F5" | Blue dot sign
|-
| style="padding: 0 5px; background: #F5F5F5" | '''[[Orchitis]]'''
| style="padding: 0 5px; background: #F5F5F5" | Acute, self-limited
| style="padding: 0 5px; background: #F5F5F5" | Yes
| style="padding: 0 5px; background: #F5F5F5" | Elevation of testis may '''relieve''' pain, may have systemic symptoms of viral illness
|-
| style="padding: 0 5px; background: #F5F5F5" | '''[[Testicular cancer]]'''
| style="padding: 0 5px; background: #F5F5F5" | Chronic, progressive
| style="padding: 0 5px; background: #F5F5F5" | No
| style="padding: 0 5px; background: #F5F5F5" | ---
|}
===Causes by Organ System===
{|style="width:85%; height:90px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Sebaceous cyst]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Thrombosis spermatic vein]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Mumps]], [[Filariasis]], [[Leprosy]], [[Orchitis]], [[Gumma|Syphilitic gumma]], [[Tuberculosis]], [[Amebiasis]], [[Epididymitis]], [[Granulomatous epididymitis]], [[Seminal vesiculitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| '''Benign:''' [[Germ cell tumor]], [[Teratoma]], [[Thecoma]], [[Sertoli-Leydig cell tumor]], [[Fibroma]], [[Chimney sweeps' carcinoma]], [[Epididymis cyst]], [[Seminal vesicle cyst]], [[Urethral gland cyst]]
'''Malignant:''' [[Germ cell tumor]], [[Seminoma]], [[Embryonal carcinoma]], [[Yolk sac tumor]], [[Choriocarcinoma]], [[Teratoma]], [[Granulosa cell tumor]], [[Sertoli-Leydig cell tumor]], [[Adenocarcinoma]], [[Mesothelioma]], [[Rhabdomyosarcoma]], [[Chimney sweeps' carcinoma]], [[Diffuse large B-cell lymphoma]]
'''Metastatic tumors:''' [[Diffuse large B-cell lymphoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Testicular injury]], [[Testicular hematoma]], [[Spermatic cord injury]], [[Fracture of testis]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| [[Hematocele]]，[[Hydrocele]]，[[Spermatocele]], [[Varicocele]], [[Testicular torsion]], [[Epididymis torsion]], [[Spermatic cord torsion]], [[Inguinal hernia]], [[Richter hernia]], [[Femoral hernia]], [[Incarcerated hernia]], [[Irreducible hernia]], [[Strangulated hernia]], [[Testicular abscess]], [[Scrotum abscess]], [[Idiopathic scrotal edema]], [[Seminal vesicle calculus]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|-
|}
==References==
{{Reflist|2}}
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==[[Scrotal mass differential diagnosis|Differential Diagnosis]]==
==[[Scrotal mass differential diagnosis|Differential Diagnosis]]==

Revision as of 14:12, 18 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD[2]Sujit Routray, M.D. [3]

Synonyms and keywords: Scrotal lump

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Common Causes of Scrotal Mass
Adapted from American Academy of Family Physicians.[2]
Cause Clinical Presentation Diagnosis Treatment
Testicular torsion Acute unilateral pain and swelling
High position of the testicle
Abnormal cremasteric reflex
Nausea/vomiting 		Mostly clinical, with or without sonography Surgery
Torsion of the testicular appendage Acute unilateral pain
No swelling
Blue dot sign(bluish discoloration of the scrotum over the superior pole) 		Sonography Pain control
Epididymis/orchitis Acute unilateral pain and swelling
Normal position of the testicle
Erythema of the scrotal skin
Fever
Dysuria 		Mostly clinical, with or without sonography Ceftriaxone and doxyxycline
Hematocele History of trauma
Pain and swelling 		Sonography or surgerical exploraion Main focus on pain control. Surgery, if needed
Inguinal hernia Unilateral bulge in the scrotum
Pain with Valsalva maneuvers 		Physical examination, sonography Surgery
Hydrocele Swelling Transillumination, sonography Main focus on pain control. Surgery, if needed
Varicocele Dull testicular ache while in standing position

Scrotal mass

"Bag of worms" on palpation Scrotal support, surgery if needed
Testicular cancer Unilateral, firm nodule Sonography, positive tumor markers Surgery
Skin cancer History of carcinogens
Erosive, vascular, hyperkeratotic, or nonhealing; irregular border; color changes 		Biopsy Surgery

Causes by Anatomic Origin

Scrotal Mass
Adapted from American Academy of Family Physicians.[2]
Anatomical Origin Lesion/Condition Onset/Progression Pain/Tenderness Aggravating/Alleviating Factors, Associated Symptoms
Skin Sebaceous cyst Acute/chronic, stable No ---
Squamous cell carcinoma Chronic, progressive No ---
Tunica vaginalis testis Hydrocele Acute/chronic, stable No Positive transillumination
Hematocele Acute, caused by trauma Yes Negative transillumination
Processus vaginalis testis Indirect inguinal hernia Acute/chronic, stable or progressive No; yes, if strangulated May enlarge with Valsalva-type maneuvers; size may fluctuate
Hydrocele Chronic, stable No ---
Pampiniform plexus Varicocele Chronic, stable No Characteristic "bag of worms" consistency
Epididymis Epididymitis Acute, progressive Yes May have symptoms of urinary tract infection (fever, chills, dysuria, frequency, and urgency)
Spermatocele Chronic, stable No ---
Testis Testicular torsion Acute, progressive Yes Elevation of testis may aggravate pain; abnormal testicular lie; cremasteric reflex usually absent
Appendix testis torsion Acute, stable Yes Blue dot sign
Orchitis Acute, self-limited Yes Elevation of testis may relieve pain, may have systemic symptoms of viral illness
Testicular cancer Chronic, progressive No ---

Causes by Organ System

Cardiovascular No underlying causes
Chemical / poisoning No underlying causes
Dermatologic Sebaceous cyst
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic Thrombosis spermatic vein
Iatrogenic No underlying causes
Infectious Disease Mumps, Filariasis, Leprosy, Orchitis, Syphilitic gumma, Tuberculosis, Amebiasis, Epididymitis, Granulomatous epididymitis, Seminal vesiculitis
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying causes
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Benign: Germ cell tumor, Teratoma, Thecoma, Sertoli-Leydig cell tumor, Fibroma, Chimney sweeps' carcinoma, Epididymis cyst, Seminal vesicle cyst, Urethral gland cyst

Malignant: Germ cell tumor, Seminoma, Embryonal carcinoma, Yolk sac tumor, Choriocarcinoma, Teratoma, Granulosa cell tumor, Sertoli-Leydig cell tumor, Adenocarcinoma, Mesothelioma, Rhabdomyosarcoma, Chimney sweeps' carcinoma, Diffuse large B-cell lymphoma

Metastatic tumors: Diffuse large B-cell lymphoma

Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma Testicular injury, Testicular hematoma, Spermatic cord injury, Fracture of testis
Urologic Hematocele，Hydrocele，Spermatocele, Varicocele, Testicular torsion, Epididymis torsion, Spermatic cord torsion, Inguinal hernia, Richter hernia, Femoral hernia, Incarcerated hernia, Irreducible hernia, Strangulated hernia, Testicular abscess, Scrotum abscess, Idiopathic scrotal edema, Seminal vesicle calculus
Miscellaneous No underlying causes

References

  1. ↑ Causes of scrotal masses. The Urology Group 2016. http://urologygroup.com/conditions-we-treat/scrotal-masses/. Accessed on March 17, 2016
  2. ↑ 2.0 2.1 Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016


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Diagnostic study of choice | Evaluation of Scrotal Mass | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | CT-Scan Findings | MRI Findings | Biopsy | Other Imaging Findings | Other Diagnostic Studies

Case Studies

Case #1

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