Scrotal mass causes

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

Overview

Scrotal mass may be caused by tumor, infection, injury, inflammation, or fluid buildup, which can cause different types of masses.

Causes

Common Causes

Scrotal mass may be caused by tumor, infection, injury, inflammation, or fluid buildup, which can cause different types of masses.

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.
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, Leprous, 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

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