Scrotal masses
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| 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.
ALL INTRATESTICULAR MASSES ARE CONSIDERED CANCER UNLESS PROVEN OTHERWISE
Causes
Causes in Alphabetical Order[1] [2]
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 & duration of symptoms
- Trauma
- Past/family history
- Sexual history
Symptoms
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
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T2: Adenomatoid tumor
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T2: Adenomatoid tumor
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STIR: Adenomatoid tumor
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T1 pre contrast: Adenomatoid tumor
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T1 post GAD: Adenomatoid tumor
CT Findings
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Hydrocele
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Hydrocele
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Varicocele
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Varicocele
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Varicocele
Echocardiography or Ultrasound
- Ultrasound should be performed on all patients
- Doppler if suspicion of torsion
Ultrasound
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Epididymal cyst
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Epididymal cyst
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Large epididymal cyst
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Large epididymal cyst
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Large epididymal cyst
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Hydrocele
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Hydrocele
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Varicocele
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Varicocele
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Varicocele
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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