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

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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.

Diagnosis

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

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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.