Scrotal masses

Scrotal masses
Testes: Lymphoma. Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

WikiDoc Resources for Scrotal masses
Articles
Most recent articles on Scrotal masses Most cited articles on Scrotal masses Review articles on Scrotal masses Articles on Scrotal masses in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Scrotal masses Images of Scrotal masses Photos of Scrotal masses Podcasts & MP3s on Scrotal masses Videos on Scrotal masses
Evidence Based Medicine
Cochrane Collaboration on Scrotal masses Bandolier on Scrotal masses TRIP on Scrotal masses
Clinical Trials
Ongoing Trials on Scrotal masses at Clinical Trials.gov Trial results on Scrotal masses Clinical Trials on Scrotal masses at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Scrotal masses NICE Guidance on Scrotal masses NHS PRODIGY Guidance FDA on Scrotal masses CDC on Scrotal masses
Books
Books on Scrotal masses
News
Scrotal masses in the news Be alerted to news on Scrotal masses News trends on Scrotal masses
Commentary
Blogs on Scrotal masses
Definitions
Definitions of Scrotal masses
Patient Resources / Community
Patient resources on Scrotal masses Discussion groups on Scrotal masses Patient Handouts on Scrotal masses Directions to Hospitals Treating Scrotal masses Risk calculators and risk factors for Scrotal masses
Healthcare Provider Resources
Symptoms of Scrotal masses Causes & Risk Factors for Scrotal masses Diagnostic studies for Scrotal masses Treatment of Scrotal masses
Continuing Medical Education (CME)
CME Programs on Scrotal masses
International
Scrotal masses en Espanol Scrotal masses en Francais
Business
Scrotal masses in the Marketplace Patents on Scrotal masses
Experimental / Informatics
List of terms related to Scrotal masses

Steven C. Campbell, M.D., Ph.D.,C. Michael Gibson, M.S., M.D. [1]

Overview

A mass in the scrotum can be in the contents of the scrotum, the wall, or the scrotum itself. All scrotal masses should be evaluated via surgical investigation. Scrotal masses are separated into two categories: Painful and nonpainful masses.

Torsion is painful and may require surgical intervention. Scrotal swelling that does not contain a mass is most likely associated with a different medical condition such as heart failure or edema.

NOTE:ALL INTRATESTICULAR MASSES ARE CONSIDERED CANCER UNLESS PROVEN OTHERWISE.

Causes

Causes in Alphabetical Order

Painful

• Blunt trauma
• Cavernous lymphangioma torsion
• Cysticercosis
• Dermoid cyst (children)
• Epididymitis
• Hematocele
• Hydrocele
• Orchitis
• Scrotal abscess
• Spermatocele torsion
• Testicular torsion
• Testicular appendage torsion

Non-Painful

• Epididymal cyst
• Hydrocele
• Scrotal hernia
• Scrotal swelling
• Spermatocele
• Sperm granuloma
• Strangulated hernia
• Testicular Cancer
• Varicocele

Diagnosis

History

• Onset and duration of symptoms
• Trauma
• Past/family history
• Sexual history

Symptoms

• Fever
• Weight loss
• Pain
• Enlarged lymph nodes

Physical Examination

Testicles

• Compare the size, tenderness and position.
• Palpatate spermatic cord.
• Transilluminate areas that could potentially contain a mass.
• Explore cords and canals for hernia, tenderness etc.
• Digital rectal exam

Epididymitis

In patients with epididymitis, the pain will be relieved upon lifting the testicle above the symphysis pubis.

Laboratory Findings

• Labs include:

• CBC
• Urethral gram
• Urinalysis
• Urethral culture

Chest X Ray

• Required if solid mass is found.

MRI and CT

• Abdominal CT if solid mass is found.

MRI Findings

T2: Adenomatoid tumor	T2: Adenomatoid tumor	STIR:Adenomatoid tumor

---

T1 pre contrast: Adenomatoid tumor	T1 post GAD: Adenomatoid tumor

CT Findings

Hydrocele	Hydrocele

Varicocele	Varicocele	Varicocele

Echocardiography or Ultrasound

• Ultrasound should be performed on all patients.
• Doppler if suspicion of torsion.

Ultrasound

Epididymal cyst	Epididymal cyst

Large epididymal cyst	Large epididymal cyst	Large epididymal cyst

Hydrocele	Hydrocele

Varicocele	Varicocele

Varicocele	Varicocele

Other Diagnostic Studies

• If solid mass found consider serum tumor markers, LDH, electrolytes, BUN / creatinine.
• Urology consult

Treatment

Torsion

• Considered an emergency.
• Penetrate spermatic cord with 10-20mL 1% lidocaine and gently twist testicles to the left and right.
• Relief should be evident immediately upon relief of torsion.
• Surgery is indicated if unsuccessful.

Acute Pharmacotherapies

Epididymitis

• Treat with antibiotics and analgesics.

Orchitis

• Treat with antibiotics and analgesics.