Scrotal mass differential diagnosis

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

Overview

Scrotal masses may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies from other diseases that cause testicular mass with discomfort, back pain, abdominal discomfort, or abdominal mass. Common differential diagnoses include yolk sac tumor, teratoma, choriocarcinoma, embryonal cell carcinoma, seminoma, and testicular lymphoma (usually non-Hodgkin lymphoma).

Differential Diagnosis

The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.

Scrotal Swelling	Diseases	Clinical manifestations									Para-clinical findings				Gold standard	Associated
Painful		Symptoms				Physical examination
											Lab Findings		Past Medical History	Histopathology
		Unilateral /Bilateral swelling	Onset	Fever	Urinary symptoms	Tenderness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Urine Analysis	Doppler U/S
	Epididymoorchitis	Unilateral	Gradual	±	Dysuria, frequency, and/or urgency	+	_	Pyuria					Hydrocele	Acute infection is characterized by infiltration of neutrophils. Chronic cases are characterized by granulomatous inflammation.	Color Doppler ultrasound
	Testicular Torsion	Unilateral	Sudden	-		+	+	_		_	Normal	Absent or decreased arterial perfusion of the testis			Color Doppler ultrasound
	Torsion of testicular appendix	Unilateral	Sudden	-		+	+	_		_	Normal	Absent or decreased arterial perfusion of the testis			Color Doppler ultrasound	prepubertal period
	Hematocele					+
	Incarcerated Hernia					-
	Testicular Abcess					-
	Brucellosis					-
	Mumps					-
	Histoplasma
	Gonorrhea
	Fournier's gangrene
Scrotal Swelling	Diseases	Unilateral /Bilateral swelling	Lab 3	Fever	Urinary symptoms	Tenderness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Urine Analysis	Doppler U/S	Past Medical History	Histopathology	Gold standard	Additional findings
Painless	Fragile XMacroorchidism					-		+
	Testicular Tumors					-		+
	Henoch-Schonlein purpura					-		-
	Hydrocele					-		-
	Varicocele					-		-
	Spermatocele					-		-
	Inguino-scrotal hernia					-		-
	Scrotal edema					-		-
	Epididymal cyst
	Scrotal oedema
	Sebaceous cyst
	Carcinoma of the scrotum
	Chylocele (Filariasis)
	Cystic dysplasia
	Srotoliths